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General NPI Number Information
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NPI Number | 1750100699
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Entity Type | Individual
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Provider Name | PIERCE KATAHDIN DIMAURO NP
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Gender | Male
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Dates
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Enumeration Date | 10/08/2024
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Last Update Date | 10/08/2024
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Provider Practice Location Address
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Address Line | 630 W 168TH ST
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City | NEW YORK
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State | NY
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Zip | 10032-3725
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Country | US
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Telephone | 212-305-7340
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Fax |
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Provider Business Mailing Address
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Address Line | 415 E 72ND ST APT 2FE
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City | NEW YORK
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State | NY
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Zip | 10021-0099
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Country | US
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Telephone | 207-812-6697
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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 | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 433077
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License Number State | NY
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