Provider Demographics
NPI:1518441625
Name:DWYER, ERIC JAMES (RN)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:JAMES
Last Name:DWYER
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 SWEZEY ST
Mailing Address - Street 2:
Mailing Address - City:EAST PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-5702
Mailing Address - Country:US
Mailing Address - Phone:631-552-2741
Mailing Address - Fax:
Practice Address - Street 1:210 SWEZEY ST
Practice Address - Street 2:
Practice Address - City:EAST PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-5702
Practice Address - Country:US
Practice Address - Phone:631-552-2741
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-24
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY753101163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health