Provider Demographics
NPI:1366510596
Name:NEWMAN, DALE M (FNP)
Entity type:Individual
Prefix:
First Name:DALE
Middle Name:M
Last Name:NEWMAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:874 STATE ROUTE 43
Mailing Address - Street 2:
Mailing Address - City:STEPHENTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:12169-1917
Mailing Address - Country:US
Mailing Address - Phone:518-733-6856
Mailing Address - Fax:
Practice Address - Street 1:295 RIVER ST
Practice Address - Street 2:TROY VA
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180
Practice Address - Country:US
Practice Address - Phone:518-274-7707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2013-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA179115363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1013640Medicaid
MA0712531Medicaid
VT1013640Medicaid
MA0712531Medicaid