Provider Demographics
NPI:1376898692
Name:MONCAYO, DIANA M
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:M
Last Name:MONCAYO
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 1:27 SIMMONS LN
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-4721
Mailing Address - Country:US
Mailing Address - Phone:917-200-5985
Mailing Address - Fax:718-816-3488
Practice Address - Street 1:27 SIMMONS LN
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-4721
Practice Address - Country:US
Practice Address - Phone:917-200-5985
Practice Address - Fax:718-816-3488
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-24
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator