Healthcare Provider Details

I. General information

NPI: 1083864094
Provider Name (Legal Business Name): DENISE DIPAUL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2008
Last Update Date: 09/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 MINE HILL RD
OTISVILLE NY
10963-3108
US

IV. Provider business mailing address

5 MINE HILL RD
OTISVILLE NY
10963-3108
US

V. Phone/Fax

Practice location:
  • Phone: 845-386-8048
  • Fax:
Mailing address:
  • Phone: 845-386-8048
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: