Provider Demographics
NPI:1215950092
Name:DIFIORI, JOHN (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:DIFIORI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:535 E 70TH ST
Mailing Address - Street 2:ATTENTION: JOHN DIFIORI MD
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-4823
Mailing Address - Country:US
Mailing Address - Phone:212-606-1635
Mailing Address - Fax:917-260-3211
Practice Address - Street 1:535 E 70TH ST
Practice Address - Street 2:ATTENTION: JOHN DIFIORI MD
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-4823
Practice Address - Country:US
Practice Address - Phone:212-606-1635
Practice Address - Fax:917-260-3211
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG74087207Q00000X, 207QS0010X, 207XX0005X, 222Z00000X
NY291887207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G740870Medicaid
CA00G740870Medicaid
CADH541ZMedicare PIN
CAWG74087CMedicare PIN
CAWG74087AMedicare PIN