Provider Demographics
NPI:1548305956
Name:DILLON, KERRI ELIZABETH
Entity type:Individual
Prefix:
First Name:KERRI
Middle Name:ELIZABETH
Last Name:DILLON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 BALSAM DR
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11763-4303
Mailing Address - Country:US
Mailing Address - Phone:631-332-8083
Mailing Address - Fax:
Practice Address - Street 1:31 BALSAM DR
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:NY
Practice Address - Zip Code:11763-4303
Practice Address - Country:US
Practice Address - Phone:631-332-8083
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2012-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist