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General NPI Number Information
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NPI Number | 1639160088
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Entity Type | Individual
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Provider Name | MICHAEL J DICLEMENTE M.D.
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Gender | Male
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Dates
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Enumeration Date | 11/03/2005
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Last Update Date | 11/06/2024
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Provider Practice Location Address
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Address Line | 7 W 51ST ST FL 4
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City | NEW YORK
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State | NY
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Zip | 10019-6910
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Country | US
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Telephone | 516-532-8149
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Fax |
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Provider Business Mailing Address
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Address Line | 5036 JERICHO TPKE STE 205
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City | COMMACK
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State | NY
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Zip | 11725-2812
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Country | US
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Telephone | 516-417-3488
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Fax | 516-584-6717
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | L6357
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | C1-0024788
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License Number State | DE
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Taxonomy #3
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number | 330169
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License Number State | NY
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