Doctor Name: | JEFFREY DINIZIO |
NPI Number: | 1427442680 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | 018514 |
Business Practice Address: | 37 Wildwood Calverton, NY - 11933 |
Business Phone Number: | 6319018892 |
Business Fax Number: | |
Mailing Address: | 37 Wildwood Dr, CALVERTON |
State: | NY |
Postal Code: | 119331129 |
Phone Number: | 6319028892 |
Fax Number: | |
NPI Enumeration Date: | 03/26/2015 |
NPI Last Update Date: | 03/26/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | 018514 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |