Provider Demographics
NPI:1134693377
Name:DIMARTINO, IRISMARIE (SPECIAL EDUCATION)
Entity Type:Individual
Prefix:
First Name:IRISMARIE
Middle Name:
Last Name:DIMARTINO
Suffix:
Gender:F
Credentials:SPECIAL EDUCATION
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:372 PETER AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-4614
Mailing Address - Country:US
Mailing Address - Phone:917-816-3290
Mailing Address - Fax:
Practice Address - Street 1:4131 RICHMOND AVE FL 2
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-5633
Practice Address - Country:US
Practice Address - Phone:718-351-0308
Practice Address - Fax:718-966-1864
Is Sole Proprietor?:No
Enumeration Date:2019-01-21
Last Update Date:2019-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYAHZ-106470001OtherMERCER