Healthcare Provider Details

I. General information

NPI: 1578884888
Provider Name (Legal Business Name): DINDO UY DEYTO P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2010
Last Update Date: 06/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

463 W 142ND ST
NEW YORK NY
10031-6217
US

IV. Provider business mailing address

4720 CENTER BLVD APT. 219
LONG ISLAND CITY NY
11109-5619
US

V. Phone/Fax

Practice location:
  • Phone: 212-281-6531
  • Fax:
Mailing address:
  • Phone: 718-864-9454
  • Fax: 718-606-1940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number023766
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: