Individual
DWIGHT CARLTON DE RISI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1010 NORTHERN BLVD, GREAT NECK, NY 11021-5306
(516) 487-8888
(516) 487-8887
Mailing address
1500 ROUTE 112 BLDG 4, PORT JEFFERSON STATION, NY 11776-8055
(631) 751-3000
(631) 509-6559
Taxonomy
Speciality
Code
Description
License number
State
2086X0206X
Surgical Oncology Physician
Primary
124921
NY
Other
Enumeration date
01/26/2006
Last updated
01/17/2020
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