Provider Demographics
NPI:1679602858
Name:DYSON, DEBORAH B (PA)
Entity Type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:B
Last Name:DYSON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MS
Other - First Name:DEBORAH
Other - Middle Name:B
Other - Last Name:DYSON-STOCKNOFF
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA
Mailing Address - Street 1:20 TAYLOR LN
Mailing Address - Street 2:
Mailing Address - City:WEST PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07424-3105
Mailing Address - Country:US
Mailing Address - Phone:973-345-9270
Mailing Address - Fax:973-345-9270
Practice Address - Street 1:462 1ST AVE
Practice Address - Street 2:9 EAST 2
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-9196
Practice Address - Country:US
Practice Address - Phone:212-263-8065
Practice Address - Fax:212-263-8251
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000812363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant