Provider Demographics
NPI:1184242588
Name:DICICCO MURRAY, DINA
Entity type:Individual
Prefix:
First Name:DINA
Middle Name:
Last Name:DICICCO MURRAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 NEW HAMPSHIRE AVE
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-3917
Mailing Address - Country:US
Mailing Address - Phone:516-238-4030
Mailing Address - Fax:
Practice Address - Street 1:119 NEW HAMPSHIRE AVE
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-3917
Practice Address - Country:US
Practice Address - Phone:516-238-4030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-12
Last Update Date:2020-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004224-1208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation