1750332292 NPI number — STEVEN J DIBIASE MD

Table of content: STEVEN J DIBIASE MD (NPI 1750332292)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750332292 NPI number — STEVEN J DIBIASE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DIBIASE
Provider First Name:
STEVEN
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1750332292
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/10/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5645 MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FLUSHING
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11355-5045
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-670-1501
Provider Business Mailing Address Fax Number:
718-445-9846

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5645 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FLUSHING
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11355-5045
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-670-1501
Provider Business Practice Location Address Fax Number:
718-445-9846
Provider Enumeration Date:
05/12/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085R0001X , with the licence number:  MA62363 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0001X , with the licence number: MD.207369 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0001X , with the licence number: 226271-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 30033191 . This is a "KEYSTONE MERCY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 010005160 . This is a "AMERICHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5936559 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2377833 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0000272 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1992518 . This is a "UNITED HEALTHCRE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 951589 . This is a "INDEPENDENCE BC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1249872 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1172691 . This is a "HORIZON NJ HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 36650 . This is a "UNIVERSITY HEALTHPLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 920007642 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: P2800817 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2179915000 . This is a "AMERIHEALTH, KEYSTONE, IBC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3208581 . This is a "AETNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".