Provider Demographics
NPI:1154671386
Name:DINO, JILLIAN (MED, MPS, TVI)
Entity Type:Individual
Prefix:MISS
First Name:JILLIAN
Middle Name:
Last Name:DINO
Suffix:
Gender:F
Credentials:MED, MPS, TVI
Other - Prefix:MISS
Other - First Name:JILLIAN
Other - Middle Name:
Other - Last Name:PRISCO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED, MPS, TVI
Mailing Address - Street 1:320 W 38TH ST APT 1910
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10018-5237
Mailing Address - Country:US
Mailing Address - Phone:914-906-8474
Mailing Address - Fax:
Practice Address - Street 1:292 MADISON AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-6307
Practice Address - Country:US
Practice Address - Phone:212-418-0320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-14
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist