Provider Demographics
NPI:1962894097
Name:HAMILTON, DEAN PHILLIP
Entity type:Individual
Prefix:
First Name:DEAN
Middle Name:PHILLIP
Last Name:HAMILTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1430 NEWBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:NORTH BELLMORE
Mailing Address - State:NY
Mailing Address - Zip Code:11710-1632
Mailing Address - Country:US
Mailing Address - Phone:516-503-7970
Mailing Address - Fax:
Practice Address - Street 1:535 E. 70TH ST
Practice Address - Street 2:
Practice Address - City:NEW
Practice Address - State:NY
Practice Address - Zip Code:10021-0000
Practice Address - Country:US
Practice Address - Phone:212-606-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-26
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018478363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical