Provider Demographics
NPI:1376634584
Name:DITROLIO, DINO (DPM)
Entity Type:Individual
Prefix:DR
First Name:DINO
Middle Name:
Last Name:DITROLIO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 150TH ST
Mailing Address - Street 2:
Mailing Address - City:WHITESTONE
Mailing Address - State:NY
Mailing Address - Zip Code:11357-1747
Mailing Address - Country:US
Mailing Address - Phone:718-767-0202
Mailing Address - Fax:718-767-7375
Practice Address - Street 1:64 FAIRVIEW AVE
Practice Address - Street 2:
Practice Address - City:WESTWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07675-2241
Practice Address - Country:US
Practice Address - Phone:201-664-0225
Practice Address - Fax:201-664-0561
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2022-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004493213ES0103X, 213ES0131X
NJMD001931213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01131442Medicaid
NJ5581109Medicaid
NY15402Medicare PIN
NJ5581109Medicaid
NJ0834220001Medicare NSC
NJDI736812Medicare PIN