Provider Demographics
NPI:1801203757
Name:DR. MARY DYER
Entity Type:Organization
Organization Name:DR. MARY DYER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:DYER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-255-0977
Mailing Address - Street 1:1-3 HENRY W DUBOIS DR
Mailing Address - Street 2:
Mailing Address - City:NEW PALTZ
Mailing Address - State:NY
Mailing Address - Zip Code:12561-1420
Mailing Address - Country:US
Mailing Address - Phone:845-255-0977
Mailing Address - Fax:845-255-0933
Practice Address - Street 1:1-3 HENRY W DUBOIS DR
Practice Address - Street 2:
Practice Address - City:NEW PALTZ
Practice Address - State:NY
Practice Address - Zip Code:12561-1420
Practice Address - Country:US
Practice Address - Phone:845-255-0977
Practice Address - Fax:845-255-0933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-11
Last Update Date:2014-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2086491305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization