Provider Demographics
NPI:1558300087
Name:GARRIGAN, DIANE MARIE (DO)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:MARIE
Last Name:GARRIGAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BEDFORD HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:10507-1814
Mailing Address - Country:US
Mailing Address - Phone:914-666-2220
Mailing Address - Fax:914-666-2987
Practice Address - Street 1:1000 MONTAUK HWY
Practice Address - Street 2:
Practice Address - City:WEST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11795-4927
Practice Address - Country:US
Practice Address - Phone:952-595-1101
Practice Address - Fax:612-294-4903
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2201762085R0202X, 2085R0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0205XAllopathic & Osteopathic PhysiciansRadiologyRadiological Physics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02204346Medicaid
NYE89897Medicare UPIN
NY525S41Medicare ID - Type Unspecified