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General NPI Number Information
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NPI Number | 1518467844
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Entity Type | Individual
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Provider Name | DWAYNE PATTERSON
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Gender | Male
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Dates
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Enumeration Date | 02/13/2018
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Last Update Date | 02/13/2018
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Provider Practice Location Address
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Address Line | 25 AVENUE D
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City | NEW YORK
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State | NY
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Zip | 10009-6935
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Country | US
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Telephone | 646-395-4400
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Fax |
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Provider Business Mailing Address
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Address Line | 15608 RIVERSIDE DR W APT 5J
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City | NEW YORK
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State | NY
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Zip | 10032-7008
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Country | US
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Telephone | 929-810-8783
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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 | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State |
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