=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063611135
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MORGAN JOY DWYER PA-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/17/2007
-----------------------------------------------------
Last Update Date | 04/27/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1 GUTHRIE SQ
-----------------------------------------------------
City | SAYRE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18840-1625
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-888-5858
-----------------------------------------------------
Fax | 570-882-3007
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 29 N CHEMUNG ST
-----------------------------------------------------
City | WAVERLY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14892-1211
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 607-565-9975
-----------------------------------------------------
Fax | 607-565-2683
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363AM0700X
-----------------------------------------------------
Taxonomy Name | Medical Physician Assistant
-----------------------------------------------------
License Number | 011917
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363AM0700X
-----------------------------------------------------
Taxonomy Name | Medical Physician Assistant
-----------------------------------------------------
License Number | MA053458
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------