Provider Demographics
NPI:1730299330
Name:DYER, RITA
Entity Type:Individual
Prefix:MRS
First Name:RITA
Middle Name:
Last Name:DYER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 NORTHBRIDGE PL
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-5761
Mailing Address - Country:US
Mailing Address - Phone:973-539-5790
Mailing Address - Fax:
Practice Address - Street 1:ST. VINCENT'S NURSING HOME
Practice Address - Street 2:315 E. LINDSLEY ROAD
Practice Address - City:CEDAR GROVE
Practice Address - State:NJ
Practice Address - Zip Code:07009
Practice Address - Country:US
Practice Address - Phone:973-754-4857
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NN03903900363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJS59896Medicare UPIN
NJ012874B8AMedicare ID - Type Unspecified