Healthcare Provider Details

I. General information

NPI: 1568644748
Provider Name (Legal Business Name): DAVID M. DINES, M.D.,P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2007
Last Update Date: 11/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

935 NORTHERN BLVD SUITE 303
GREAT NECK NY
11021-5316
US

IV. Provider business mailing address

935 NORTHERN BLVD SUITE 303
GREAT NECK NY
11021-5316
US

V. Phone/Fax

Practice location:
  • Phone: 516-482-1037
  • Fax:
Mailing address:
  • Phone: 516-482-1037
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. MARY JEAN LOGAN
Title or Position: OFFICE MANAGER
Credential:
Phone: 516-482-1037