Healthcare Provider Details

I. General information

NPI: 1043287873
Provider Name (Legal Business Name): GEORGE DIRAGO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2006
Last Update Date: 03/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

359 N CENTRAL AVE
HARTSDALE NY
10530-1811
US

IV. Provider business mailing address

359 N CENTRAL AVE
HARTSDALE NY
10530-1811
US

V. Phone/Fax

Practice location:
  • Phone: 914-448-2273
  • Fax: 914-448-2200
Mailing address:
  • Phone: 914-448-2273
  • Fax: 914-448-2200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number25MA03904700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: