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General NPI Number Information
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NPI Number | 1255334363
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Entity Type | Individual
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Provider Name | KAREN RENATE DYBUS RPA
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Gender | Female
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Dates
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Enumeration Date | 05/23/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | STUDENT HEALTH SERVICE STADIUM ROAD
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City | STONY BROOK
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State | NY
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Zip | 11794-3191
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Country | US
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Telephone | 631-632-6739
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Fax | 631-632-6936
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Provider Business Mailing Address
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Address Line | 10 TODD CT
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City | SOUTH HUNTINGTON
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State | NY
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Zip | 11746-4224
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Country | US
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Telephone | 631-470-3243
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 4005-01
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License Number State | NY
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