Provider Demographics
NPI:1043237779
Name:SIXSMITH, DIANE M (MD)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:M
Last Name:SIXSMITH
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1981 MARCUS AVE
Mailing Address - Street 2:SUITE 208
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042-1038
Mailing Address - Country:US
Mailing Address - Phone:718-670-1651
Mailing Address - Fax:516-437-4167
Practice Address - Street 1:56-45 MAIN ST
Practice Address - Street 2:NEW YORK HOSPITAL MEDICAL CENTER OF QUEENS EMERGENCY DE
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355
Practice Address - Country:US
Practice Address - Phone:718-670-1231
Practice Address - Fax:516-437-4167
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2010-11-02
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Provider Licenses
StateLicense IDTaxonomies
NY122203207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00229896Medicaid
B13519Medicare UPIN
NY00229896Medicaid
NYP00613922Medicare PIN