Provider Demographics
NPI:1770585531
Name:DYSON, DUANE J (MD)
Entity type:Individual
Prefix:DR
First Name:DUANE
Middle Name:J
Last Name:DYSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 W GILBERT ST
Mailing Address - Street 2:2ND FL
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-4918
Mailing Address - Country:US
Mailing Address - Phone:732-212-0060
Mailing Address - Fax:732-212-0061
Practice Address - Street 1:530 NEW BRUNSWICK AVE
Practice Address - Street 2:
Practice Address - City:PERTH AMBOY
Practice Address - State:NJ
Practice Address - Zip Code:08861-3674
Practice Address - Country:US
Practice Address - Phone:732-442-3700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05627000207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5042500Medicaid
NJP00329644OtherRAILROAD MEDICARE
NJ17984OtherUHP NON PAR #
NJ702482ZCS7Medicare PIN
NJ702482DQMMedicare PIN
NJF09841Medicare UPIN
NJ702482Medicare ID - Type Unspecified
NJ5042500Medicaid
NJ702482S6SMedicare PIN
NJ702482XZ2Medicare PIN
NJ702482MK3Medicare PIN
NJ702482MK5Medicare PIN
NJ702482UWYMedicare PIN
NJP00329644OtherRAILROAD MEDICARE
NJ702482UXXMedicare PIN
NJ702482DPKMedicare PIN
NJ702482DLEMedicare PIN
NJ17984OtherUHP NON PAR #
NJ702482VGNMedicare PIN
NJ175224SN3Medicare PIN
NJ175224VGNMedicare PIN