Provider Demographics
NPI:1417362021
Name:YILDIRIM, DIANA MATIRA (MD)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:MATIRA
Last Name:YILDIRIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DIANA MARIE
Other - Middle Name:MATIRA
Other - Last Name:MALBAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1 DIAMOND HILL RD
Mailing Address - Street 2:
Mailing Address - City:BERKELEY HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:07922-2104
Mailing Address - Country:US
Mailing Address - Phone:908-273-4300
Mailing Address - Fax:
Practice Address - Street 1:1 SEYMOUR ST
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-3771
Practice Address - Country:US
Practice Address - Phone:973-744-6939
Practice Address - Fax:973-744-0365
Is Sole Proprietor?:No
Enumeration Date:2014-06-23
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR1818208000000X
NY290822208000000X
390200000X
NJ25MA10944700208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program