Healthcare Provider Details

I. General information

NPI: 1477488641
Provider Name (Legal Business Name): THOMAS DIMAURO LPN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67 LINCOLN RD
MONROE NY
10950-5005
US

IV. Provider business mailing address

67 LINCOLN RD
MONROE NY
10950-5005
US

V. Phone/Fax

Practice location:
  • Phone: 914-456-9349
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number322534-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: