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General NPI Number Information
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NPI Number | 1801203757
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Entity Type | Organization
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Legal Business Name | DR. MARY DYER
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Dates
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Enumeration Date | 07/11/2014
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Last Update Date | 07/11/2014
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Provider Practice Location Address
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Address Line | 1-3 HENRY W DUBOIS DR
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City | NEW PALTZ
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State | NY
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Zip | 12561-1420
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Country | US
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Telephone | 845-255-0977
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Fax | 845-255-0933
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Provider Business Mailing Address
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Address Line | 1-3 HENRY W DUBOIS DR
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City | NEW PALTZ
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State | NY
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Zip | 12561-1420
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Country | US
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Telephone | 845-255-0977
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Fax | 845-255-0933
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Authorized Official
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Title or Position | M.D.
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Name | MARY ELLEN DYER
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Credential | M.D.
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Telephone | 845-255-0977
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | 2086491
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License Number State | NY
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