Provider Demographics
NPI:1679766547
Name:DIANE M DEN HAESE MEDICAL SERVICES PLLC
Entity Type:Organization
Organization Name:DIANE M DEN HAESE MEDICAL SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:M
Authorized Official - Last Name:DEN HAESE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-989-1033
Mailing Address - Street 1:6415 LANDSTONE DR
Mailing Address - Street 2:
Mailing Address - City:CLARENCE CENTER
Mailing Address - State:NY
Mailing Address - Zip Code:14032-9403
Mailing Address - Country:US
Mailing Address - Phone:716-989-1033
Mailing Address - Fax:716-631-9525
Practice Address - Street 1:1540 MAPLE RD
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14221-3647
Practice Address - Country:US
Practice Address - Phone:716-568-3600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-23
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY244252207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty