Healthcare Provider Details

I. General information

NPI: 1982614350
Provider Name (Legal Business Name): FERDINAND C. DIBLASIO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 07/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 SOUTHDOWN RD
HUNTINGTON NY
11743-2538
US

IV. Provider business mailing address

21 SOUTHDOWN RD
HUNTINGTON NY
11743-2538
US

V. Phone/Fax

Practice location:
  • Phone: 631-351-3763
  • Fax: 631-385-8210
Mailing address:
  • Phone: 631-351-3763
  • Fax: 631-385-8210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number102982-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: