Healthcare Provider Details

I. General information

NPI: 1477526531
Provider Name (Legal Business Name): GERALD GENNARO DIMASO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2006
Last Update Date: 01/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

68 SEGUINE AVE
STATEN ISLAND NY
10309-3723
US

IV. Provider business mailing address

39 DORA LN
HOLMDEL NJ
07733-1672
US

V. Phone/Fax

Practice location:
  • Phone: 718-356-6500
  • Fax: 718-356-0348
Mailing address:
  • Phone: 732-888-1975
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number170623
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number170623
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: