Provider Demographics
NPI:1952726283
Name:TYSON, PETER GREGORY JR (BA)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:GREGORY
Last Name:TYSON
Suffix:JR
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:590 6TH AVE
Mailing Address - Street 2:11TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-2019
Mailing Address - Country:US
Mailing Address - Phone:646-300-3213
Mailing Address - Fax:212-660-1344
Practice Address - Street 1:590 6TH AVE
Practice Address - Street 2:11TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-2019
Practice Address - Country:US
Practice Address - Phone:646-300-3213
Practice Address - Fax:212-660-1344
Is Sole Proprietor?:No
Enumeration Date:2014-02-24
Last Update Date:2014-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker