Provider Demographics
NPI:1740674753
Name:MICHAEL J. DIMAIO D.C., P.C.
Entity type:Organization
Organization Name:MICHAEL J. DIMAIO D.C., P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:DIMAIO
Authorized Official - Suffix:
Authorized Official - Credentials:CDCC
Authorized Official - Phone:631-909-1700
Mailing Address - Street 1:306 WADING RIVER RD
Mailing Address - Street 2:
Mailing Address - City:MANORVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11949-3444
Mailing Address - Country:US
Mailing Address - Phone:631-909-1700
Mailing Address - Fax:
Practice Address - Street 1:306 WADING RIVER RD
Practice Address - Street 2:
Practice Address - City:MANORVILLE
Practice Address - State:NY
Practice Address - Zip Code:11949-3444
Practice Address - Country:US
Practice Address - Phone:631-909-1700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-27
Last Update Date:2015-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX055961111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX055961OtherPTAN
NY1801079223OtherINDIVIDUAL NPI NUMBER