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General NPI Number Information
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NPI Number | 1174595490
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Entity Type | Individual
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Provider Name | DIMITRI GHECAS PA-C
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Gender | Male
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Dates
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Enumeration Date | 02/02/2006
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Last Update Date | 06/18/2024
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Provider Practice Location Address
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Address Line | 11 OLD PARK LANE
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City | NEW MILFORD
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State | CT
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Zip | 06776
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Country | US
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Telephone | 860-355-1149
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Fax | 860-355-5957
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Provider Business Mailing Address
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Address Line | 11 OLD PARK LANE
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City | NEW MILFORD
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State | CT
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Zip | 06776
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Country | US
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Telephone | 860-355-1149
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Fax | 860-355-5957
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 00735
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 022592
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License Number State | NY
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