Provider Demographics
NPI:1952408031
Name:DALTON, LINDA MARIE (PA-C)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:MARIE
Last Name:DALTON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:MARIE
Other - Last Name:KERESTES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:31-41 45TH STREET
Mailing Address - Street 2:
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11103
Mailing Address - Country:US
Mailing Address - Phone:718-721-1500
Mailing Address - Fax:718-777-5934
Practice Address - Street 1:31-41 45TH STREET
Practice Address - Street 2:
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11103
Practice Address - Country:US
Practice Address - Phone:718-721-1500
Practice Address - Fax:718-777-5934
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA17907363A00000X
NY006943363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY006943OtherNEW YORK STATE
CAPA17907OtherPA LICENSE NUMBER