Provider Demographics
NPI:1467693481
Name:NOSWORTHY, DINA MARIE (CM)
Entity Type:Individual
Prefix:MS
First Name:DINA
Middle Name:MARIE
Last Name:NOSWORTHY
Suffix:
Gender:F
Credentials:CM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 BLEECKER ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10012-2413
Mailing Address - Country:US
Mailing Address - Phone:212-274-7250
Mailing Address - Fax:
Practice Address - Street 1:26 BLEECKER ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10012-2413
Practice Address - Country:US
Practice Address - Phone:212-274-7250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-21
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF0011581367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03405649Medicaid