Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 210557 | NY |
NPI | 1174693170 |
---|---|
Provider Name | David Samuel Dinello |
First Address | Marcellus, NY 13108 |
Second Address | Marcellus, NY 13108 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2006 |
Last Update Date | 26/05/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
J400003161 | PTAN # WITH NORTH MEDICAL, PC (01) | NY |