Provider Demographics
NPI:1629366372
Name:DIENER, BARRY LAWRENCE (MD)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:LAWRENCE
Last Name:DIENER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1559
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-0989
Mailing Address - Country:US
Mailing Address - Phone:631-444-8014
Mailing Address - Fax:631-444-6045
Practice Address - Street 1:4 TECHNOLOGY DR
Practice Address - Street 2:
Practice Address - City:EAST SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-4080
Practice Address - Country:US
Practice Address - Phone:631-444-8340
Practice Address - Fax:631-444-6045
Is Sole Proprietor?:No
Enumeration Date:2011-07-15
Last Update Date:2014-06-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD4419362080P0214X
NY2740912080P0214X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric Pulmonology