Active NPI
Bill David Dienstag, PAC
- Physician Assistant
- Elmira, NY
National Provider Identifier
1104120575
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 006144
- Practice address
- 600 Ivy St
Suite 201
Elmira, NY 14905-1627 - Phone
- (607) 737-7780
- Fax
- (607) 737-7788
- NPI assigned
- Dec 29, 2010
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 006144 | NY | Primary |
Addresses
Primary practice location
600 Ivy St
Suite 201
Elmira, NY 14905-1627
Mailing address
571 Saint Josephs Blvd FL 2
Elmira, NY 14901-3230
Phone (607) 271-2050
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 006144 | Other | NY | NY STATE LICENSE |
| 04297325 | Medicaid | NY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 006144 | NY | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1293580800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1678147200000",
"number": "1104120575",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "571 SAINT JOSEPHS BLVD FL 2",
"city": "ELMIRA",
"state": "NY",
"postal_code": "149013230",
"telephone_number": "607-271-2050"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "600 IVY ST",
"address_2": "SUITE 201",
"city": "ELMIRA",
"state": "NY",
"postal_code": "149051627",
"telephone_number": "607-737-7780",
"fax_number": "607-737-7788"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DIENSTAG",
"first_name": "BILL",
"middle_name": "DAVID",
"name_prefix": "Mr.",
"credential": "PAC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-12-29",
"last_updated": "2023-03-07",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NY",
"license": "006144",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NY STATE LICENSE",
"identifier": "006144",
"state": "NY"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "04297325",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Elmira, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.