Provider Demographics
NPI:1568644748
Name:DAVID M. DINES, M.D.,P.C.
Entity Type:Organization
Organization Name:DAVID M. DINES, M.D.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY JEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LOGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-482-1037
Mailing Address - Street 1:935 NORTHERN BLVD
Mailing Address - Street 2:SUITE 303
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-5316
Mailing Address - Country:US
Mailing Address - Phone:516-482-1037
Mailing Address - Fax:
Practice Address - Street 1:935 NORTHERN BLVD
Practice Address - Street 2:SUITE 303
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-5316
Practice Address - Country:US
Practice Address - Phone:516-482-1037
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-29
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC05518Medicare UPIN