Provider Demographics
NPI:1477741510
Name:CONNIE L DIMARI
Entity Type:Organization
Organization Name:CONNIE L DIMARI
Other - Org Name:CONNIE L DIMARI
Other - Org Type:Other Name
Authorized Official - Title/Position:SOLO PRACTICE
Authorized Official - Prefix:
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:DIMARI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-265-4122
Mailing Address - Street 1:334 KINDERKAMACK RD
Mailing Address - Street 2:
Mailing Address - City:ORADELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07649
Mailing Address - Country:US
Mailing Address - Phone:201-265-4122
Mailing Address - Fax:201-265-8457
Practice Address - Street 1:334 KINDERKAMACK RD
Practice Address - Street 2:
Practice Address - City:ORADELL
Practice Address - State:NJ
Practice Address - Zip Code:07649
Practice Address - Country:US
Practice Address - Phone:201-265-4122
Practice Address - Fax:201-265-8457
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-12
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ449735Medicare PIN
B10742Medicare UPIN