Provider Demographics
NPI:1659025773
Name:DIMARTINO, MORAY (MS RDMT LP-LCAT)
Entity Type:Individual
Prefix:
First Name:MORAY
Middle Name:
Last Name:DIMARTINO
Suffix:
Gender:F
Credentials:MS RDMT LP-LCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 WOODBINE ST APT 4B
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11221-4301
Mailing Address - Country:US
Mailing Address - Phone:516-241-2114
Mailing Address - Fax:
Practice Address - Street 1:27 WOODBINE ST APT 4B
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11221-4301
Practice Address - Country:US
Practice Address - Phone:516-241-2114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-08
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR-2744225600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225600000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDance Therapist