Provider Demographics
NPI:1982614350
Name:DIBLASIO, FERDINAND C (MD)
Entity Type:Individual
Prefix:
First Name:FERDINAND
Middle Name:C
Last Name:DIBLASIO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 SOUTHDOWN RD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-2538
Mailing Address - Country:US
Mailing Address - Phone:631-351-3763
Mailing Address - Fax:631-385-8210
Practice Address - Street 1:21 SOUTHDOWN RD
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-2538
Practice Address - Country:US
Practice Address - Phone:631-351-3763
Practice Address - Fax:631-385-8210
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY102982-1208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2C4876OtherHEALTHNET
NY1000505OtherGHI
NY00627023Medicaid
NY694521OtherBLUE CROSS/ BLUE SHIELD
NYCS113OtherOXFORD
NY694521Medicare ID - Type Unspecified
NY1000505OtherGHI