MEDICARE: DR. JOHN RICHARD DIMARINIS DPM PODIATRIST

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	213E00000X	Podiatrist	0024251	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	70644	OTHER	NY	GHI
2	P2759	OTHER	NY	BLUE CROSS

General Provider Information

NPI Number	:	1598880817
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN RICHARD DIMARINIS DPM PODIATRIST

Provider Business Mailing Address
First Line	:	4801 42 STREET
Second Line	:	2A
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11104-3117
Country	:	US
Telephone Number	:	718-729-8999
Fax Number	:

Provider Business Practice Location Address
First Line	:	4801 42 STREET
Second Line	:	2A
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11104-3117
Country	:	US
Telephone Number	:	718-729-8999
Fax Number	:

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

Provider Enumeration Date	:	03/20/2007
Last Update Date	:	07/08/2007

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