Provider Demographics
NPI:1689702748
Name:IGOE-DIAZ, MAUREEN (FNP)
Entity Type:Individual
Prefix:MS
First Name:MAUREEN
Middle Name:
Last Name:IGOE-DIAZ
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7214 LOUBET ST
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-6723
Mailing Address - Country:US
Mailing Address - Phone:718-459-4037
Mailing Address - Fax:
Practice Address - Street 1:200 WEST 57TH STREET
Practice Address - Street 2:SUITE 608
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019
Practice Address - Country:US
Practice Address - Phone:212-581-4488
Practice Address - Fax:212-581-4141
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2009-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF331005363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY95N241Medicare ID - Type Unspecified