Provider Demographics
NPI:1891020251
Name:DILLON, GEORGE (PTA)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:
Last Name:DILLON
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 SACHEM ST
Mailing Address - Street 2:
Mailing Address - City:EAST ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11518-1315
Mailing Address - Country:US
Mailing Address - Phone:516-437-5300
Mailing Address - Fax:516-437-2936
Practice Address - Street 1:8 SACHEM ST
Practice Address - Street 2:
Practice Address - City:EAST ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11518-1315
Practice Address - Country:US
Practice Address - Phone:516-437-5300
Practice Address - Fax:516-437-2936
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-02
Last Update Date:2009-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003867174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist