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General NPI Number Information
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NPI Number | 1578160131
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Entity Type | Individual
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Provider Name | ISABELLA DI MARE PA-C
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Gender | Female
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Dates
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Enumeration Date | 10/07/2020
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Last Update Date | 10/07/2020
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Provider Practice Location Address
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Address Line | 130 FORT WASHINGTON AVE
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City | NEW YORK
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State | NY
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Zip | 10032-4724
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Country | US
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Telephone | 212-543-1700
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Fax | 212-543-1707
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Provider Business Mailing Address
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Address Line | 112 W 80TH ST
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City | NEW YORK
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State | NY
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Zip | 10024-6329
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Country | US
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Telephone | 813-422-4739
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Fax |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 02546001
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License Number State | NY
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