Provider Demographics
NPI:1013942481
Name:DIMANT, MENAHEM (MD)
Entity type:Individual
Prefix:
First Name:MENAHEM
Middle Name:
Last Name:DIMANT
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 1:1250 WATERS PL
Mailing Address - Street 2:TOWER 1 SUITE 602
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-2720
Mailing Address - Country:US
Mailing Address - Phone:347-640-6211
Mailing Address - Fax:718-944-1529
Practice Address - Street 1:THREE BARKER AVENUE
Practice Address - Street 2:4TH FLOOR PARK AVENUE MEDICAL ASSOCIATES PC
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10601
Practice Address - Country:US
Practice Address - Phone:914-949-1199
Practice Address - Fax:914-949-1245
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY162455207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00935180Medicaid
NY00935180Medicaid
B16251Medicare UPIN