Provider Demographics
NPI:1841549656
Name:DYLAG, JOAN M (MED)
Entity type:Individual
Prefix:MRS
First Name:JOAN
Middle Name:M
Last Name:DYLAG
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1451 INDIAN FALLS RD
Mailing Address - Street 2:
Mailing Address - City:CORFU
Mailing Address - State:NY
Mailing Address - Zip Code:14036-9750
Mailing Address - Country:US
Mailing Address - Phone:585-507-8730
Mailing Address - Fax:
Practice Address - Street 1:1451 INDIAN FALLS RD
Practice Address - Street 2:
Practice Address - City:CORFU
Practice Address - State:NY
Practice Address - Zip Code:14036-9750
Practice Address - Country:US
Practice Address - Phone:585-507-8730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-07
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY666474174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist