Healthcare Provider Details

I. General information

NPI: 1649212697
Provider Name (Legal Business Name): DANTE D MASTRONARDI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 06/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

229-231 STATE ST FL 4
BINGHAMTON NY
13901-2756
US

IV. Provider business mailing address

229-231 STATE ST FL 4
BINGHAMTON NY
13901-2756
US

V. Phone/Fax

Practice location:
  • Phone: 607-778-1126
  • Fax: 607-778-1164
Mailing address:
  • Phone: 607-778-1152
  • Fax: 607-778-1162

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LC1500X
TaxonomyCommunity Health Nurse Practitioner
License NumberF320026
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberF401065
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: