Provider Demographics
NPI:1164784021
Name:DYMBORT, DAVID ABE (RPH)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:ABE
Last Name:DYMBORT
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 EDGEMERE TER
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07882-4131
Mailing Address - Country:US
Mailing Address - Phone:908-835-8995
Mailing Address - Fax:
Practice Address - Street 1:410 TOMPKINS AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11216-2207
Practice Address - Country:US
Practice Address - Phone:718-789-3220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-15
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY035934-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist