Provider Demographics
NPI:1184866568
Name:DINTENFASS, JOHN I (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:I
Last Name:DINTENFASS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 EAST 68TH STREET
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:NEW YORK CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10021-4955
Mailing Address - Country:US
Mailing Address - Phone:212-288-6919
Mailing Address - Fax:
Practice Address - Street 1:11 EAST 68TH STREET
Practice Address - Street 2:SUITE 1B
Practice Address - City:NEW YORK CITY
Practice Address - State:NY
Practice Address - Zip Code:10021-4955
Practice Address - Country:US
Practice Address - Phone:212-288-6919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-31
Last Update Date:2009-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY102710103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst