Healthcare Provider Details

I. General information

NPI: 1376634584
Provider Name (Legal Business Name): DINO DITROLIO DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 11/11/2022
Certification Date: 11/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64 FAIRVIEW AVE
WESTWOOD NJ
07675-2241
US

IV. Provider business mailing address

1225 150TH ST
WHITESTONE NY
11357-1747
US

V. Phone/Fax

Practice location:
  • Phone: 201-664-0225
  • Fax: 201-664-0561
Mailing address:
  • Phone: 718-767-0202
  • Fax: 718-767-7375

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberN004493
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberN004493
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberMD001931
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: