Provider Demographics
NPI:1598729220
Name:DENNIS, LYLE JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:LYLE
Middle Name:JAMES
Last Name:DENNIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:20 GRAND STREET
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:WARWICK
Mailing Address - State:NY
Mailing Address - Zip Code:10990-1035
Mailing Address - Country:US
Mailing Address - Phone:845-987-3901
Mailing Address - Fax:845-987-5979
Practice Address - Street 1:257 LAFAYETTE AVE
Practice Address - Street 2:
Practice Address - City:SUFFERN
Practice Address - State:NY
Practice Address - Zip Code:10901-4830
Practice Address - Country:US
Practice Address - Phone:845-368-8808
Practice Address - Fax:845-368-5608
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA070782002084N0400X
WI777882084N0400X, 2084V0102X
VA01012763332084V0102X
NY2055622084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084V0102XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyVascular Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ037867Medicare ID - Type Unspecified
H03697Medicare UPIN