MEDICARE: TONIA DIMBO LPN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	242071-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	242071-1	OTHER	NY	LICENSE NUMBER

General Provider Information

NPI Number	:	1427440734
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TONIA DIMBO LPN

Provider Business Mailing Address
First Line	:	802 OLD COUNTRY RD
Second Line	:
City	:	ELMSFORD
State	:	NY
Zip	:	10523-2022
Country	:	US
Telephone Number	:	914-336-6489
Fax Number	:

Provider Business Practice Location Address
First Line	:	802 OLD COUNTRY RD
Second Line	:
City	:	ELMSFORD
State	:	NY
Zip	:	10523-2022
Country	:	US
Telephone Number	:	914-336-6489
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/24/2015
Last Update Date	:	02/24/2015

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