Provider Demographics
NPI:1235513813
Name:NATHANS, DIANA
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:NATHANS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13411 KEW GARDENS RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:NY
Mailing Address - Zip Code:11418-1930
Mailing Address - Country:US
Mailing Address - Phone:718-441-0155
Mailing Address - Fax:718-850-4720
Practice Address - Street 1:13411 KEW GARDENS RD
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:NY
Practice Address - Zip Code:11418-1930
Practice Address - Country:US
Practice Address - Phone:718-441-0155
Practice Address - Fax:718-850-4720
Is Sole Proprietor?:No
Enumeration Date:2015-07-14
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY920261152174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist