Provider Demographics
NPI:1992130348
Name:ISRAELOV, DINA (CM)
Entity type:Individual
Prefix:
First Name:DINA
Middle Name:
Last Name:ISRAELOV
Suffix:
Gender:F
Credentials:CM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1180 BRIGHTON BEACH AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-5876
Mailing Address - Country:US
Mailing Address - Phone:718-833-8777
Mailing Address - Fax:718-646-8400
Practice Address - Street 1:1180 BRIGHTON BEACH AVE STE 1
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-5876
Practice Address - Country:US
Practice Address - Phone:718-833-8777
Practice Address - Fax:718-646-8400
Is Sole Proprietor?:No
Enumeration Date:2013-09-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NYF001603367A00000X
NYP90263363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical