Provider Demographics
NPI:1508908005
Name:CORREIA, DIANE S (DO)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:S
Last Name:CORREIA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:711 STEWART AVENUE
Mailing Address - Street 2:SUITE 114
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530
Mailing Address - Country:US
Mailing Address - Phone:516-227-3254
Mailing Address - Fax:516-998-4078
Practice Address - Street 1:711 STEWART AVENUE
Practice Address - Street 2:SUITE 114
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530
Practice Address - Country:US
Practice Address - Phone:516-227-3254
Practice Address - Fax:516-998-4078
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY175615 1207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F35464Medicare UPIN