Distant, Dale A.

Distant, Dale A. is an individual health care provider with primary practice located at 450 Clarkson Ave Suite C, Brooklyn NY 11203-2056. He recently has only one registered license in Allopathic & Osteopathic Physicians / Surgery, which is considered as his primary health care specialty. Distant, Dale A. can be contacted via phone (718) 270-1422.

Contact Information

Primary practice address
450 Clarkson Ave Suite C Brooklyn NY 11203-2056
Phone: (718) 270-1422
Fax: (718) 270-2826
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Surgery 208600000X 190405-1 New York

Profile Details

NPI number 1285612077
LBN Legal business name Distant, Dale A.
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 3rd, 2006
Last updated Jul 8th, 2007 - about 19 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

Request for update

Identifiers

StateTypeNumberIssuer
All States NPI 1285612077 NPPES
New York MEDICAID 01438926

Popular Providers