Provider Demographics
NPI:1093918237
Name:KRASNOPOLSKI, DIANA (NP)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:KRASNOPOLSKI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4223 FRANCIS LEWIS BLVD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361-2580
Mailing Address - Country:US
Mailing Address - Phone:718-225-5106
Mailing Address - Fax:718-225-0816
Practice Address - Street 1:4223 FRANCIS LEWIS BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11361-2580
Practice Address - Country:US
Practice Address - Phone:718-225-5106
Practice Address - Fax:718-225-0816
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-06
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF303634363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF303634OtherLICENSE
NYMK1344415OtherDEA