Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | 124643 | NY |
NPI | 1972656452 |
---|---|
Provider Name | David M Dines |
First Address | Great Neck, NY 11021-5309 |
Second Address | Uniondale, NY 11553-3645 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/01/2007 |
Last Update Date | 30/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C05518 | (02) | NY |