Provider Demographics
NPI:1497930960
Name:ROBERT M. DIMICELI
Entity Type:Organization
Organization Name:ROBERT M. DIMICELI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:M
Authorized Official - Last Name:DIMICELI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:718-965-7188
Mailing Address - Street 1:666 10TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-4502
Mailing Address - Country:US
Mailing Address - Phone:718-965-7188
Mailing Address - Fax:718-768-7739
Practice Address - Street 1:666 10TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-4502
Practice Address - Country:US
Practice Address - Phone:718-965-7188
Practice Address - Fax:718-768-7739
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-03
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004223213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0790340001Medicare NSC