Basic Information
| Provider Information | |||||||||
| NPI: | 1023624749 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DUN | ||||||||
| FirstName: | MARIA | ||||||||
| MiddleName: | SUSAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3948 RICHMOND AVE | ||||||||
| Address2: | |||||||||
| City: | STATEN ISLAND | ||||||||
| State: | NY | ||||||||
| PostalCode: | 103125111 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7183561789 | ||||||||
| FaxNumber: | 7183561777 | ||||||||
| Practice Location | |||||||||
| Address1: | 3948 RICHMOND AVE | ||||||||
| Address2: | |||||||||
| City: | STATEN ISLAND | ||||||||
| State: | NY | ||||||||
| PostalCode: | 103125111 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7183561789 | ||||||||
| FaxNumber: | 7183561777 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/17/2020 | ||||||||
| LastUpdateDate: | 09/17/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/17/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 033889 | NY | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.