Provider Demographics
NPI:1750554713
Name:WHITESTONE PODIATRY PC
Entity type:Organization
Organization Name:WHITESTONE PODIATRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DINO
Authorized Official - Middle Name:
Authorized Official - Last Name:DITROLIO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:718-767-0202
Mailing Address - Street 1:1225 150TH ST
Mailing Address - Street 2:
Mailing Address - City:WHITESTONE
Mailing Address - State:NY
Mailing Address - Zip Code:11357-1747
Mailing Address - Country:US
Mailing Address - Phone:718-767-0202
Mailing Address - Fax:718-767-7375
Practice Address - Street 1:1225 150TH STREET
Practice Address - Street 2:
Practice Address - City:WHITESTONE
Practice Address - State:NY
Practice Address - Zip Code:11357-1747
Practice Address - Country:US
Practice Address - Phone:718-767-0202
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-10
Last Update Date:2015-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004493213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYT81579Medicare UPIN
NY15402Medicare PIN
NY6200460001Medicare NSC