Basic Information
Provider Information
NPI: 1477804151
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: STEIN
FirstName: DYLAN
MiddleName: J
NamePrefix: DR.
NameSuffix:  
Credential: DNP, RN, CPNP-PC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1275 YORK AVE
Address2:  
City: NEW YORK
State: NY
PostalCode: 100656007
CountryCode: US
TelephoneNumber: 2126392000
FaxNumber:  
Practice Location
Address1: 1275 YORK AVE
Address2:  
City: NEW YORK
State: NY
PostalCode: 10065
CountryCode: US
TelephoneNumber: 2126392000
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/21/2012
LastUpdateDate: 01/05/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 01/05/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
163W00000X740009-1NYN Nursing Service ProvidersRegistered Nurse 
171100000X25004916NYN Other Service ProvidersAcupuncturist 
363LP0200X382974NYY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics

No ID Information.


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