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General NPI Number Information
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NPI Number | 1952726283
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Entity Type | Individual
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Provider Name | PETER GREGORY TYSON JR. BA
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Gender | Male
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Dates
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Enumeration Date | 02/24/2014
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Last Update Date | 01/06/2026
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Provider Practice Location Address
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Address Line | 848 E 37TH ST APT 1
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City | BROOKLYN
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State | NY
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Zip | 11210-1937
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Country | US
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Telephone | 347-782-0345
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Fax |
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Provider Business Mailing Address
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Address Line | 590 6TH AVE 11TH FLOOR
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City | NEW YORK
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State | NY
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Zip | 10011-2019
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Country | US
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Telephone | 646-300-3213
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Fax | 212-660-1344
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 100834
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License Number State | NY
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