Healthcare Provider Details

I. General information

NPI: 1750554713
Provider Name (Legal Business Name): WHITESTONE PODIATRY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2008
Last Update Date: 12/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 150TH STREET
WHITESTONE NY
11357-1747
US

IV. Provider business mailing address

1225 150TH ST
WHITESTONE NY
11357-1747
US

V. Phone/Fax

Practice location:
  • Phone: 718-767-0202
  • Fax:
Mailing address:
  • Phone: 718-767-0202
  • Fax: 718-767-7375

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberN004493
License Number StateNY

VIII. Authorized Official

Name: DINO DITROLIO
Title or Position: PRESIDENT
Credential: DPM
Phone: 718-767-0202