Provider Demographics
NPI:1457409120
Name:DIMINO, IGNAZIO JAMES (PA)
Entity type:Individual
Prefix:MR
First Name:IGNAZIO
Middle Name:JAMES
Last Name:DIMINO
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:7 HANNAH MOUNT DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:08510-1723
Mailing Address - Country:US
Mailing Address - Phone:718-283-6000
Mailing Address - Fax:718-283-8498
Practice Address - Street 1:4802 10TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-2916
Practice Address - Country:US
Practice Address - Phone:718-283-6000
Practice Address - Fax:718-283-8498
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY007169363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical