Healthcare Provider Details

I. General information

NPI: 1346890589
Provider Name (Legal Business Name): PAULINE BERNADETTE DIMAANO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2019
Last Update Date: 06/16/2025
Certification Date: 12/30/2020
Deactivation Date: 12/30/2020
Reactivation Date: 06/16/2025

III. Provider practice location address

30 PROSPECT AVENUE
HACKENSACK NJ
07601
US

IV. Provider business mailing address

30 PROSPECT AVENUE
HACKENSACK NJ
07601
US

V. Phone/Fax

Practice location:
  • Phone: 551-996-2017
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: