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General NPI Number Information
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NPI Number | 1679109714
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Entity Type | Individual
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Provider Name | GARY L DILLON JR. PHD
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Gender | Male
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Dates
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Enumeration Date | 03/20/2020
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Last Update Date | 02/06/2021
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Provider Practice Location Address
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Address Line | 137 E 25TH ST
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City | NEW YORK
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State | NY
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Zip | 10010-2314
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Country | US
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Telephone | 516-777-0661
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Fax |
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Provider Business Mailing Address
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Address Line | 90 STATE ST STE OFFICE40
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City | ALBANY
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State | NY
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Zip | 12207-1716
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Country | US
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Telephone | 347-770-2559
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 023245
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License Number State | NY
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