1518331651 NPI number — DAWN TREE NURSE PRACTITIONER IN PSYCHIATRY, PLLC

Table of content: (NPI 1518331651)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518331651 NPI number — DAWN TREE NURSE PRACTITIONER IN PSYCHIATRY, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DAWN TREE NURSE PRACTITIONER IN PSYCHIATRY, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
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Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1518331651
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/29/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15 MILEWOOD RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VERBANK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12585-5023
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-594-8370
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1133 ROUTE 55
Provider Second Line Business Practice Location Address:
C/O ADVANCED CLINICIAN SUPPORT SERVICES, INC
Provider Business Practice Location Address City Name:
LAGRANGEVILLE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12540-5051
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-594-8370
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/29/2015

Additional Information

Authorized Official

Authorized Official Last Name:
TREE
Authorized Official First Name:
DAWN
Authorized Official Middle Name:
R
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
845-594-8370

Provider Taxonomy Codes

  • Taxonomy code: 363LP0808X , with the licence number:  401679 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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