Provider Demographics
NPI:1083765192
Name:ZEMBA, DIANE G (DC)
Entity Type:Individual
Prefix:DR
First Name:DIANE
Middle Name:G
Last Name:ZEMBA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 W MAIN ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11702-3018
Mailing Address - Country:US
Mailing Address - Phone:631-669-1345
Mailing Address - Fax:631-669-1496
Practice Address - Street 1:430 W MAIN ST
Practice Address - Street 2:SUITE A
Practice Address - City:BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11702-3018
Practice Address - Country:US
Practice Address - Phone:631-669-1345
Practice Address - Fax:631-669-1496
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2012-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX004667-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC04667-4OtherWCB AUTHORIZATION NO.
NYDZ0X280010Medicare ID - Type Unspecified
NY350022050Medicare UPIN
NYT53036Medicare UPIN