Healthcare Provider Details

I. General information

NPI: 1588725709
Provider Name (Legal Business Name): ANTHONY DIMARINO D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 04/06/2021
Certification Date: 04/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 ISLAND PT
BRONX NY
10464-1477
US

IV. Provider business mailing address

29 ISLAND PT
BRONX NY
10464-1477
US

V. Phone/Fax

Practice location:
  • Phone: 914-837-8434
  • Fax:
Mailing address:
  • Phone: 914-837-8402
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberN003546
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: