Provider Demographics
NPI:1699913806
Name:DIMANT, NATALIYA (FNP)
Entity type:Individual
Prefix:
First Name:NATALIYA
Middle Name:
Last Name:DIMANT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1159 BRIGHTON BEACH AVE
Mailing Address - Street 2:APT 2E
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-5961
Mailing Address - Country:US
Mailing Address - Phone:415-203-0537
Mailing Address - Fax:
Practice Address - Street 1:719 OCEANVIEW AVENUE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235
Practice Address - Country:US
Practice Address - Phone:718-934-0322
Practice Address - Fax:718-934-0994
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-26
Last Update Date:2009-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF335767-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY610712-1OtherLICENSE