Provider Demographics
NPI:1891841920
Name:DIMARI, CONNIE LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:CONNIE
Middle Name:LEE
Last Name:DIMARI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-6609
Mailing Address - Country:US
Mailing Address - Phone:212-807-6120
Mailing Address - Fax:212-807-6121
Practice Address - Street 1:114E 27TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-8969
Practice Address - Country:US
Practice Address - Phone:212-807-6120
Practice Address - Fax:212-683-4361
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2015-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY147391207W00000X
NJ47783207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY64208OtherUNITED HEALTH CARE
NYP407820OtherOXFORD
NY9751276OtherCIGNA
NY64208OtherUNITED HEALTH CARE
NY9751276OtherCIGNA
NY19D521Medicare ID - Type Unspecified