Provider Demographics
NPI:1407267032
Name:DURACAK, DINO (PT, DPT)
Entity Type:Individual
Prefix:
First Name:DINO
Middle Name:
Last Name:DURACAK
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:771 MARY ST
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13501-1842
Mailing Address - Country:US
Mailing Address - Phone:315-601-1210
Mailing Address - Fax:
Practice Address - Street 1:2050 TILDEN AVE
Practice Address - Street 2:
Practice Address - City:NEW HARTFORD
Practice Address - State:NY
Practice Address - Zip Code:13413-3613
Practice Address - Country:US
Practice Address - Phone:315-737-2423
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-16
Last Update Date:2015-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY038682-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01815443Medicaid
NY00313539Medicaid
NY335475Medicare Oscar/Certification
NY00313539Medicaid