Provider Demographics
NPI:1447307616
Name:DIMITRI, JOHN F (DC)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:F
Last Name:DIMITRI
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:116 BILTMORE AVE
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11769-1157
Mailing Address - Country:US
Mailing Address - Phone:631-750-3824
Mailing Address - Fax:631-224-8940
Practice Address - Street 1:11 CARLETON AVE
Practice Address - Street 2:
Practice Address - City:EAST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11730-2108
Practice Address - Country:US
Practice Address - Phone:631-224-7474
Practice Address - Fax:631-224-8940
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009881111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYY30256Medicare UPIN
NYXBWLD1Medicare ID - Type Unspecified