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General NPI Number Information
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NPI Number | 1689750259
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Entity Type | Individual
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Provider Name | NADYA E DIMITROV DPM
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Gender | Female
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Dates
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Enumeration Date | 10/27/2006
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Last Update Date | 12/11/2012
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Provider Practice Location Address
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Address Line | 10 UNION SQ E 2N
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City | NEW YORK
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State | NY
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Zip | 10003-3314
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Country | US
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Telephone | 212-420-4300
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Fax | 212-420-2310
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Provider Business Mailing Address
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Address Line | 350 OLD WILLETS PATH
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City | SMITHTOWN
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State | NY
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Zip | 11787-4120
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Country | US
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Telephone | 212-420-4300
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Fax | 631-724-3252
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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 | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | N004243
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License Number State | NY
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