Provider Demographics
NPI:1124017165
Name:VECCHIO, DIANE M (FNP)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:M
Last Name:VECCHIO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2099 COUNTY HIGHWAY 107
Mailing Address - Street 2:
Mailing Address - City:AMSTERDAM
Mailing Address - State:NY
Mailing Address - Zip Code:12010-6220
Mailing Address - Country:US
Mailing Address - Phone:518-842-9340
Mailing Address - Fax:
Practice Address - Street 1:5010 STATE HIGHWAY 30
Practice Address - Street 2:SUITE 205
Practice Address - City:AMSTERDAM
Practice Address - State:NY
Practice Address - Zip Code:12010-7532
Practice Address - Country:US
Practice Address - Phone:518-842-2663
Practice Address - Fax:518-842-4861
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF332466-1363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02406866Medicaid
NYP89441Medicare UPIN
NYDD5686Medicare ID - Type UnspecifiedMEDICARE PROVIDER #