Provider Demographics
NPI:1598880817
Name:DIMARINIS, JOHN RICHARD (DPM PODIATRIST)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:RICHARD
Last Name:DIMARINIS
Suffix:
Gender:M
Credentials:DPM PODIATRIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4801 42 STREET
Mailing Address - Street 2:2A
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11104-3117
Mailing Address - Country:US
Mailing Address - Phone:718-729-8999
Mailing Address - Fax:
Practice Address - Street 1:4801 42 STREET
Practice Address - Street 2:2A
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11104-3117
Practice Address - Country:US
Practice Address - Phone:718-729-8999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0024251213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY70644OtherGHI
NYP2759OtherBLUE CROSS
NY70644OtherGHI
T32068Medicare UPIN