Provider Demographics
NPI:1215701677
Name:DILLON, MITCHELL W (MS, CGC)
Entity type:Individual
Prefix:
First Name:MITCHELL
Middle Name:W
Last Name:DILLON
Suffix:
Gender:M
Credentials:MS, CGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:565 W 169TH ST APT 3C
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-3908
Mailing Address - Country:US
Mailing Address - Phone:917-426-4178
Mailing Address - Fax:
Practice Address - Street 1:565 W 169TH ST APT 3C
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-3908
Practice Address - Country:US
Practice Address - Phone:917-426-4178
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-07
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLGC676170300000X
CTGC.000096170300000X
NJ25MJ00026000170300000X
170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS