Provider Demographics
NPI:1902893126
Name:DYNE, JUDITH B (NP)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:B
Last Name:DYNE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1000 E GENESEE ST
Mailing Address - Street 2:STE 300
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-1892
Mailing Address - Country:US
Mailing Address - Phone:315-471-1044
Mailing Address - Fax:315-474-4312
Practice Address - Street 1:1000 E GENESEE ST
Practice Address - Street 2:STE 300
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-1892
Practice Address - Country:US
Practice Address - Phone:315-471-1044
Practice Address - Fax:315-474-4312
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2010-04-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NYF301606207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2310061Medicaid
NYDD3272Medicare PIN
NY2310061Medicaid