Provider Demographics
NPI:1093701161
Name:MARIN, DIANA V (MD)
Entity Type:Individual
Prefix:DR
First Name:DIANA
Middle Name:V
Last Name:MARIN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:30 BERGEN STREET
Mailing Address - Street 2:BUILDING 12 ROOM 1205
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07107-3000
Mailing Address - Country:US
Mailing Address - Phone:972-972-0037
Mailing Address - Fax:973-972-0743
Practice Address - Street 1:622 W 168TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-3720
Practice Address - Country:US
Practice Address - Phone:973-972-5188
Practice Address - Fax:973-972-2307
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2023-12-28
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Provider Licenses
StateLicense IDTaxonomies
FLME945582085P0229X
NJ25MA103110002085P0229X
NY2868072085R0202X, 2085P0229X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085P0229XAllopathic & Osteopathic PhysiciansRadiologyPediatric Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0062685Medicaid
FL274212800Medicaid
NY286807OtherNYS MEDICAL LICENSE