Provider Demographics
NPI:1720036833
Name:DILORENZO, JAMES COSTABILE (MD)
Entity Type:Individual
Prefix:MRS
First Name:JAMES
Middle Name:COSTABILE
Last Name:DILORENZO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:688 WHITE PLAINS RD
Mailing Address - Street 2:SUITE 222
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-5059
Mailing Address - Country:US
Mailing Address - Phone:914-725-9115
Mailing Address - Fax:914-725-3465
Practice Address - Street 1:688 WHITE PLAINS RD
Practice Address - Street 2:SUITE 222
Practice Address - City:SCARSDALE
Practice Address - State:NY
Practice Address - Zip Code:10583-5059
Practice Address - Country:US
Practice Address - Phone:914-725-9115
Practice Address - Fax:914-725-3465
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY182149207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01839858Medicaid
NY105871Medicare PIN
NY01839858Medicaid