Provider Demographics
NPI:1932261914
Name:DIPRIMA, JOSEPH G (DPM FAC FAS)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:G
Last Name:DIPRIMA
Suffix:
Gender:M
Credentials:DPM FAC FAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2828 BAIRD RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:FAIRPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14450
Mailing Address - Country:US
Mailing Address - Phone:585-249-0020
Mailing Address - Fax:585-586-4835
Practice Address - Street 1:2828 BAIRD RD
Practice Address - Street 2:SUITE B
Practice Address - City:FAIRPORT
Practice Address - State:NY
Practice Address - Zip Code:14450
Practice Address - Country:US
Practice Address - Phone:585-249-0020
Practice Address - Fax:585-586-4835
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2009-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003655213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY8077OtherBLUE SHIELD
NY008492162Medicaid
NY010003655OtherBLUE CHOICE
17810BMedicare PIN
NY010003655OtherBLUE CHOICE