Provider Demographics
NPI:1346461506
Name:POLIDORI, DINA (PA-C)
Entity type:Individual
Prefix:
First Name:DINA
Middle Name:
Last Name:POLIDORI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 COLFAX AVENUE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-2431
Mailing Address - Country:US
Mailing Address - Phone:917-572-5770
Mailing Address - Fax:
Practice Address - Street 1:506 SIXTH STREET
Practice Address - Street 2:NYM HOSPITAL DEPT. OF CARDIOLOGY
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-9008
Practice Address - Country:US
Practice Address - Phone:718-780-5942
Practice Address - Fax:718-780-7707
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006863363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant