Provider Demographics
NPI:1770772238
Name:LARRY DIFABRIZIO MD PC
Entity type:Organization
Organization Name:LARRY DIFABRIZIO MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:SOTIROPOULOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-517-8488
Mailing Address - Street 1:111 E 80TH ST APT 1B
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10075-0350
Mailing Address - Country:US
Mailing Address - Phone:212-517-8488
Mailing Address - Fax:212-517-5129
Practice Address - Street 1:111 E 80TH ST APT 1B
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075-0350
Practice Address - Country:US
Practice Address - Phone:212-517-8488
Practice Address - Fax:212-517-5129
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-22
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWEX801Medicare PIN