Provider Demographics
NPI:1124118344
Name:HES, DYAN (MD)
Entity type:Individual
Prefix:
First Name:DYAN
Middle Name:
Last Name:HES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 IRVING PLACE
Mailing Address - Street 2:3RD FLOOR, SOUTH
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003
Mailing Address - Country:US
Mailing Address - Phone:212-473-4200
Mailing Address - Fax:212-473-5696
Practice Address - Street 1:67 IRVING PLACE
Practice Address - Street 2:3RD FLOOR, SOUTH
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003
Practice Address - Country:US
Practice Address - Phone:212-473-4200
Practice Address - Fax:212-473-5696
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2107971208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02156403Medicaid
NY02156403Medicaid
H50121Medicare UPIN