Provider Demographics
NPI:1144361163
Name:DIGNICARE MEDICAL PLLC
Entity type:Organization
Organization Name:DIGNICARE MEDICAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DEJESUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:347-254-6462
Mailing Address - Street 1:2060 E 61ST ST
Mailing Address - Street 2:APT 1
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-5908
Mailing Address - Country:US
Mailing Address - Phone:347-254-6462
Mailing Address - Fax:718-306-5238
Practice Address - Street 1:2060 E 61ST ST
Practice Address - Street 2:APT 1
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-5908
Practice Address - Country:US
Practice Address - Phone:347-254-6462
Practice Address - Fax:718-306-5238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-11
Last Update Date:2010-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1724301207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05762OtherGHI MEDICARE
NY02377035Medicaid
NY05762OtherGHI MEDICARE