Provider Demographics
NPI:1962639096
Name:DIMIAN, MICHEL KODSI SOLIMAN (RPT)
Entity Type:Individual
Prefix:
First Name:MICHEL
Middle Name:KODSI SOLIMAN
Last Name:DIMIAN
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 PEARSON ST
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-4789
Mailing Address - Country:US
Mailing Address - Phone:718-698-3792
Mailing Address - Fax:
Practice Address - Street 1:37 PEARSON ST
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-4789
Practice Address - Country:US
Practice Address - Phone:718-698-3792
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-16
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026176225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist