MEDICARE: DAVID RANDALL DYNOF MD

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	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician	225074-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1912908989
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID RANDALL DYNOF MD

Provider Business Mailing Address
First Line	:	2341 BELLMORE AVE
Second Line	:
City	:	BELLMORE
State	:	NY
Zip	:	11710-5624
Country	:	US
Telephone Number	:	516-781-8100
Fax Number	:	516-781-8133

Provider Business Practice Location Address
First Line	:	2 CORACI BLVD
Second Line	:	STE 1
City	:	SHIRLEY
State	:	NY
Zip	:	11967-4833
Country	:	US
Telephone Number	:	212-682-2750
Fax Number	:	212-682-6588

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

Provider Enumeration Date	:	08/02/2005
Last Update Date	:	02/21/2018

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