Provider Demographics
NPI:1578160131
Name:DI MARE, ISABELLA (PA-C)
Entity Type:Individual
Prefix:
First Name:ISABELLA
Middle Name:
Last Name:DI MARE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 W 80TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-6329
Mailing Address - Country:US
Mailing Address - Phone:813-422-4739
Mailing Address - Fax:
Practice Address - Street 1:130 FORT WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-4724
Practice Address - Country:US
Practice Address - Phone:212-543-1700
Practice Address - Fax:212-543-1707
Is Sole Proprietor?:No
Enumeration Date:2020-10-07
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY02546001363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant