Provider Demographics
NPI:1225074958
Name:PALAZZO-GENTILE, DIANA (PA)
Entity Type:Individual
Prefix:MS
First Name:DIANA
Middle Name:
Last Name:PALAZZO-GENTILE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:
Other - Last Name:GENTILE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:1 FOUNTAIN LN
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-4654
Mailing Address - Country:US
Mailing Address - Phone:718-960-6697
Mailing Address - Fax:718-960-9089
Practice Address - Street 1:4487 3RD AVE
Practice Address - Street 2:ST. BARNABAS HOSPTIAL CLINIC 4TH FLOOR
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-1526
Practice Address - Country:US
Practice Address - Phone:718-960-6697
Practice Address - Fax:718-960-9089
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2018-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003015-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant