Provider Demographics
NPI:1972656452
Name:DINES, DAVID M (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:M
Last Name:DINES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:935 NORTHERN BLVD STE 303
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-5309
Mailing Address - Country:US
Mailing Address - Phone:516-482-1037
Mailing Address - Fax:516-482-9217
Practice Address - Street 1:333 EARLE OVINGTON BLVD STE 106
Practice Address - Street 2:
Practice Address - City:UNIONDALE
Practice Address - State:NY
Practice Address - Zip Code:11553-3645
Practice Address - Country:US
Practice Address - Phone:516-482-1037
Practice Address - Fax:516-482-9217
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY124643204C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC05518Medicare UPIN
NY11A231Medicare ID - Type UnspecifiedMEDICARE
NY11A231Medicare ID - Type Unspecified