Provider Demographics
NPI:1558383489
Name:TEPER, DIANA (DO)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:TEPER
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 1:8622 BAY PKWY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-4168
Mailing Address - Country:US
Mailing Address - Phone:718-333-2121
Mailing Address - Fax:718-333-9585
Practice Address - Street 1:8622 BAY PKWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-4168
Practice Address - Country:US
Practice Address - Phone:718-333-2121
Practice Address - Fax:718-333-9585
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY228151207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H89197Medicare UPIN