Provider Demographics
NPI:1083623599
Name:DRYER, STEPHEN N (CRNA)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:N
Last Name:DRYER
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 READE PL
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-3947
Mailing Address - Country:US
Mailing Address - Phone:845-431-5629
Mailing Address - Fax:845-437-3145
Practice Address - Street 1:68 S SERVICE RD
Practice Address - Street 2:SUITE 350
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-2354
Practice Address - Country:US
Practice Address - Phone:516-945-3107
Practice Address - Fax:516-945-3131
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAPRN-714367500000X
CA1922367500000X
TX746019367500000X
NY657645207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX189441202Medicaid
TX8930UBOtherBCBS
TXP00995614OtherRAILROAD
TXTXB136162Medicare PIN