Provider Demographics
NPI:1609034842
Name:KONTONOTAS-WILLIS, DIANA CATHERINE (DO)
Entity Type:Individual
Prefix:DR
First Name:DIANA
Middle Name:CATHERINE
Last Name:KONTONOTAS-WILLIS
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 1:1 HEALTHY WAY
Mailing Address - Street 2:DEPT OF EMERGENCY MEDICINE
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-1551
Mailing Address - Country:US
Mailing Address - Phone:516-632-4751
Mailing Address - Fax:516-336-2941
Practice Address - Street 1:1 HEALTHY WAY
Practice Address - Street 2:DEPT OF EMERGENCY MEDICINE
Practice Address - City:OCEANSIDE
Practice Address - State:NY
Practice Address - Zip Code:11572-1551
Practice Address - Country:US
Practice Address - Phone:516-632-4751
Practice Address - Fax:516-336-2941
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-23
Last Update Date:2011-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY252390207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine