Provider Demographics
NPI:1124069489
Name:DEMBITZER, DAVID JONATHAN (PT)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:JONATHAN
Last Name:DEMBITZER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:619 ELVIRA AVE
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-5404
Mailing Address - Country:US
Mailing Address - Phone:718-327-3037
Mailing Address - Fax:
Practice Address - Street 1:619 ELVIRA AVE
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-5404
Practice Address - Country:US
Practice Address - Phone:917-468-5253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0259911225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRB5210Medicare PIN
NY08173HMedicare PIN
NYQ16M71Medicare UPIN