Provider Demographics
NPI:1780896654
Name:DIMINO, JOSEPH (MSPT)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:
Last Name:DIMINO
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 GUYON AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-5521
Mailing Address - Country:US
Mailing Address - Phone:718-667-7700
Mailing Address - Fax:718-667-7710
Practice Address - Street 1:299 GUYON AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-4134
Practice Address - Country:US
Practice Address - Phone:718-667-7700
Practice Address - Fax:718-677-7710
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017624-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0007963400OtherAETNA
NY184064OtherELDERPLAN
NYQA 5703OtherBLUE CROSS BLUE SHIELD
NYP2055450OtherOXFORD
NY294096POtherHIP
NY184064OtherELDERPLAN