Provider Demographics
NPI:1144397548
Name:INDYK, DIANE (DO)
Entity Type:Individual
Prefix:DR
First Name:DIANE
Middle Name:
Last Name:INDYK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:JACOBI MEDICAL CENTER
Mailing Address - Street 2:1400 PELHAM PARKWAY SOUTH
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461
Mailing Address - Country:US
Mailing Address - Phone:203-353-1275
Mailing Address - Fax:718-918-4176
Practice Address - Street 1:JACOBI MEDICAL CENTER
Practice Address - Street 2:1400 PELHAM PARKWAY SOUTH
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461
Practice Address - Country:US
Practice Address - Phone:718-918-4134
Practice Address - Fax:718-918-4176
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY140247208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics