Provider Demographics
NPI:1033638523
Name:DICENSO, DINA
Entity Type:Individual
Prefix:
First Name:DINA
Middle Name:
Last Name:DICENSO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 47TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220-1311
Mailing Address - Country:US
Mailing Address - Phone:917-679-9742
Mailing Address - Fax:
Practice Address - Street 1:210 MONTROSE AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11206-2351
Practice Address - Country:US
Practice Address - Phone:718-417-1117
Practice Address - Fax:718-417-1119
Is Sole Proprietor?:No
Enumeration Date:2017-09-15
Last Update Date:2017-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY342265363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily