Healthcare Provider Details

I. General information

NPI: 1124941307
Provider Name (Legal Business Name): CITY LIFE MEDICAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 NOSTRAND AVE
BROOKLYN NY
11225-5911
US

IV. Provider business mailing address

1201 NOSTRAND AVE
BROOKLYN NY
11225-5911
US

V. Phone/Fax

Practice location:
  • Phone: 718-758-4144
  • Fax:
Mailing address:
  • Phone: 718-758-4144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL DIBARI
Title or Position: OWNER
Credential: MD
Phone: 347-956-6126