Provider Demographics
NPI:1730848979
Name:DILLON, PAUL JAMES
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:JAMES
Last Name:DILLON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:89 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-5121
Mailing Address - Country:US
Mailing Address - Phone:516-512-4850
Mailing Address - Fax:
Practice Address - Street 1:89 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-5121
Practice Address - Country:US
Practice Address - Phone:516-512-4850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-15
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant