Provider Demographics
NPI:1619628781
Name:DINOPOL, JUSTIN DAVE
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:DAVE
Last Name:DINOPOL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2831 ROLLING GREEN PL
Mailing Address - Street 2:
Mailing Address - City:MACUNGIE
Mailing Address - State:PA
Mailing Address - Zip Code:18062-1418
Mailing Address - Country:US
Mailing Address - Phone:484-226-8089
Mailing Address - Fax:
Practice Address - Street 1:3907 4TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11232-2901
Practice Address - Country:US
Practice Address - Phone:347-457-3012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-11
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048257225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist