Provider Demographics
NPI:1750332292
Name:DIBIASE, STEVEN J (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:J
Last Name:DIBIASE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5645 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-5045
Mailing Address - Country:US
Mailing Address - Phone:718-670-1501
Mailing Address - Fax:718-445-9846
Practice Address - Street 1:5645 MAIN ST
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-5045
Practice Address - Country:US
Practice Address - Phone:718-670-1501
Practice Address - Fax:718-445-9846
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2019-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA623632085R0001X
LAMD.2073692085R0001X
NY226271-12085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
30033191OtherKEYSTONE MERCY
010005160OtherAMERICHOICE
5936559OtherCIGNA
LA2377833Medicaid
NJ0000272Medicaid
1992518OtherUNITED HEALTHCRE
PA951589OtherINDEPENDENCE BC
PA1249872OtherAETNA
1172691OtherHORIZON NJ HEALTH
36650OtherUNIVERSITY HEALTHPLAN
920007642OtherRR MEDICARE
P2800817OtherOXFORD
2179915000OtherAMERIHEALTH, KEYSTONE, IBC
NJ3208581OtherAETNA
NJ0000272Medicaid
5936559OtherCIGNA
NJ3208581OtherAETNA
NJ059238VRRMedicare PIN