Healthcare Provider Details

I. General information

NPI: 1306709910
Provider Name (Legal Business Name): DAVID DIMICHELE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2025
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 CROOKED HILL RD
BRENTWOOD NY
11717-1039
US

IV. Provider business mailing address

108 COLONIAL DR
EAST PATCHOGUE NY
11772-5860
US

V. Phone/Fax

Practice location:
  • Phone: 631-231-3232
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: