Provider Demographics
NPI:1194825034
Name:D'IMPERIO, PATRICIA (DC, DIBCN)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:
Last Name:D'IMPERIO
Suffix:
Gender:F
Credentials:DC, DIBCN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 ADAMS AVE
Mailing Address - Street 2:
Mailing Address - City:BAYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11709-1330
Mailing Address - Country:US
Mailing Address - Phone:516-628-8946
Mailing Address - Fax:
Practice Address - Street 1:181 LANDAU AVE
Practice Address - Street 2:
Practice Address - City:ELMONT
Practice Address - State:NY
Practice Address - Zip Code:11003-1034
Practice Address - Country:US
Practice Address - Phone:516-354-6607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX006957-1111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU4631Medicare UPIN
NYX56541Medicare ID - Type Unspecified