Provider Demographics
NPI:1679837462
Name:VOGEL, DIANNE LORRAINE (MA)
Entity Type:Individual
Prefix:MS
First Name:DIANNE
Middle Name:LORRAINE
Last Name:VOGEL
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1054 CONNETQUOT AVE
Mailing Address - Street 2:
Mailing Address - City:CENTRAL ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11722-3231
Mailing Address - Country:US
Mailing Address - Phone:631-234-3097
Mailing Address - Fax:
Practice Address - Street 1:1014 GRAND BLVD
Practice Address - Street 2:SUITE 5
Practice Address - City:DEER PARK
Practice Address - State:NY
Practice Address - Zip Code:11729-5782
Practice Address - Country:US
Practice Address - Phone:631-243-1765
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist