Basic Information
| Provider Information | |||||||||
| NPI: | 1174296883 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DILLON | ||||||||
| FirstName: | NATASHA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 392 GRAND AVE APT 7 | ||||||||
| Address2: | |||||||||
| City: | LEONIA | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 076052215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2014750022 | ||||||||
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| Practice Location | |||||||||
| Address1: | 401 HAMBURG TPKE STE 302 | ||||||||
| Address2: | |||||||||
| City: | WAYNE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 074702139 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9737909222 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/28/2021 | ||||||||
| LastUpdateDate: | 07/28/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/18/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | 403552 | NY | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health | 363LP0808X | 26NJ01179400 | NJ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.