Provider Demographics
NPI:1346725611
Name:DIXON, DEBORAH (NYCPS)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:DIXON
Suffix:
Gender:F
Credentials:NYCPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 FLATBUSH AVE FL 3
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11217-1101
Mailing Address - Country:US
Mailing Address - Phone:718-852-2584
Mailing Address - Fax:
Practice Address - Street 1:25 FLATBUSH AVE FL 3
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11217-1101
Practice Address - Country:US
Practice Address - Phone:718-852-2584
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-02
Last Update Date:2018-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNYCPS-285175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist