MEDICARE: MS. BETH H DINKIN M.S.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number State
1	171W00000X	Contractor	NY
2	174H00000X	Health Educator	NY
3	222Q00000X	Developmental Therapist	NY

General Provider Information

NPI Number	:	1538420682
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. BETH H DINKIN M.S.

Provider Business Mailing Address
First Line	:	549 W 123RD ST APT 9G
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10027-5039
Country	:	US
Telephone Number	:	917-734-3087
Fax Number	:

Provider Business Practice Location Address
First Line	:	549 W 123RD ST APT 9G
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10027-5039
Country	:	US
Telephone Number	:	917-734-3087
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/05/2012
Last Update Date	:	06/05/2012

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