Provider Demographics
NPI:1720420235
Name:DINOVITSER MEDICAL PLLC
Entity Type:Organization
Organization Name:DINOVITSER MEDICAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:
Authorized Official - Last Name:DINOVITSER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:646-400-2482
Mailing Address - Street 1:PO BOX 201
Mailing Address - Street 2:
Mailing Address - City:SOUTH FALLSBURG
Mailing Address - State:NY
Mailing Address - Zip Code:12779-0201
Mailing Address - Country:US
Mailing Address - Phone:646-400-2482
Mailing Address - Fax:866-788-0859
Practice Address - Street 1:29 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ELLENVILLE
Practice Address - State:NY
Practice Address - Zip Code:12428-1082
Practice Address - Country:US
Practice Address - Phone:845-798-5244
Practice Address - Fax:866-788-0859
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-25
Last Update Date:2014-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY262529207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty