Healthcare Provider Details

I. General information

NPI: 1861735359
Provider Name (Legal Business Name): ARIE AMNON DADUSH M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2013
Last Update Date: 09/18/2024
Certification Date: 09/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

680 W END AVE # 1AA
NEW YORK NY
10025-6815
US

IV. Provider business mailing address

7 NOEL LN
JERICHO NY
11753-1311
US

V. Phone/Fax

Practice location:
  • Phone: 917-965-2250
  • Fax: 917-970-9114
Mailing address:
  • Phone: 646-351-4400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number298566
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD60762868
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberMD60762868
License Number StateWA
# 4
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number298566
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: