Provider Demographics
NPI:1639569544
Name:GREENSPAN, DIANA MARIE
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:MARIE
Last Name:GREENSPAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 JUNIPER ST
Mailing Address - Street 2:
Mailing Address - City:ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11751-1225
Mailing Address - Country:US
Mailing Address - Phone:631-813-8675
Mailing Address - Fax:
Practice Address - Street 1:99 JUNIPER ST
Practice Address - Street 2:
Practice Address - City:ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11751-1225
Practice Address - Country:US
Practice Address - Phone:631-813-8675
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-30
Last Update Date:2015-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY882959141174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist