MEDICARE: DAP MEDICAL CARE PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0200X	Pediatric Nurse Practitioner

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	481970922	OTHER	NY	LICENSE

General Provider Information

NPI Number	:	1376013268
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAP MEDICAL CARE PC

Provider Business Mailing Address
First Line	:	400 FORT WASHINGTON AVE APT 1C
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10033-6837
Country	:	US
Telephone Number	:	212-923-8500
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 FORT WASHINGTON AVE APT 1C
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10033-6837
Country	:	US
Telephone Number	:	212-923-8500
Fax Number	:

Authorized Official
Title or Position	:	MD
Name	:	DR. DIEGO PONIEMAN
Credential	:	MD
Telephone Number	:	212-923-8500

Provider Enumeration Date	:	12/04/2018
Last Update Date	:	12/04/2018

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Directions to “DAP MEDICAL CARE PC ” Practice Location

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