Provider Demographics
NPI:1265655252
Name:FALLON, JOHN DANIEL JR (NP)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:DANIEL
Last Name:FALLON
Suffix:JR
Gender:M
Credentials:NP
Other - Prefix:
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Mailing Address - Street 1:4232 ALBANY POST RD
Mailing Address - Street 2:
Mailing Address - City:HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12538-1766
Mailing Address - Country:US
Mailing Address - Phone:845-229-8977
Mailing Address - Fax:845-229-8930
Practice Address - Street 1:4232 ALBANY POST RD
Practice Address - Street 2:
Practice Address - City:HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:12538-1766
Practice Address - Country:US
Practice Address - Phone:845-229-8977
Practice Address - Fax:845-229-8930
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NYF331951-1363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner