Provider Demographics
NPI:1003145699
Name:MARTIRE, DIANE (MD)
Entity Type:Individual
Prefix:DR
First Name:DIANE
Middle Name:
Last Name:MARTIRE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 RIVERSIDE BLVD
Mailing Address - Street 2:APT 10 M
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10069-0701
Mailing Address - Country:US
Mailing Address - Phone:212-769-2207
Mailing Address - Fax:
Practice Address - Street 1:160 RIVERSIDE BLVD
Practice Address - Street 2:APT 10 M
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10069-0701
Practice Address - Country:US
Practice Address - Phone:212-769-2207
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-10
Last Update Date:2009-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY159251207R00000X
NJMA045328207R00000X
FLME69172207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine