Provider Demographics
NPI:1073787743
Name:ARANBAYEVA, DIANA
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:ARANBAYEVA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11211 69TH AVE
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-3917
Mailing Address - Country:US
Mailing Address - Phone:917-579-0634
Mailing Address - Fax:
Practice Address - Street 1:20811 HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:QUEENS VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11427-1711
Practice Address - Country:US
Practice Address - Phone:718-479-5017
Practice Address - Fax:718-479-0771
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-14
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010838363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant