Healthcare Provider Details

I. General information

NPI: 1215950092
Provider Name (Legal Business Name): JOHN DIFIORI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 02/01/2021
Certification Date: 02/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 E 70TH ST ATTENTION: JOHN DIFIORI MD
NEW YORK NY
10021-4823
US

IV. Provider business mailing address

535 E 70TH ST ATTENTION: JOHN DIFIORI MD
NEW YORK NY
10021-4823
US

V. Phone/Fax

Practice location:
  • Phone: 212-606-1635
  • Fax: 917-260-3211
Mailing address:
  • Phone: 212-606-1635
  • Fax: 917-260-3211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG74087
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberG74087
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberG74087
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code222Z00000X
TaxonomyOrthotist
License NumberG74087
License Number StateCA
# 5
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number291887
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: