Basic Information
| Provider Information | |||||||||
| NPI: | 1679165559 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DYLAN RC ENTERPRISES INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1086 HIGHWAY 315 BLVD | ||||||||
| Address2: | |||||||||
| City: | WILKES BARRE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 187027012 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5708237761 | ||||||||
| FaxNumber: | 5708228033 | ||||||||
| Practice Location | |||||||||
| Address1: | 693 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | NEW MILFORD | ||||||||
| State: | PA | ||||||||
| PostalCode: | 188347200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5704652027 | ||||||||
| FaxNumber: | 5704652028 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/11/2021 | ||||||||
| LastUpdateDate: | 02/11/2021 | ||||||||
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| AuthorizedOfficialLastName: | MITERKO | ||||||||
| AuthorizedOfficialFirstName: | DIANE | ||||||||
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| AuthorizedOfficialTitleorPosition: | CREDENTIALING | ||||||||
| AuthorizedOfficialTelephone: | 5708237761 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 02/11/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 261QP2000X | N | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy | 261QX0100X | N | Ambulatory Health Care Facilities | Clinic/Center | Occupational Medicine | 225100000X | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 396759 | 01 | PA | MEDICARE | OTHER |