Provider Demographics
NPI:1780034819
Name:SEO, DIANNE (DO)
Entity Type:Individual
Prefix:DR
First Name:DIANNE
Middle Name:
Last Name:SEO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 LONGVIEW AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10601-5000
Mailing Address - Country:US
Mailing Address - Phone:914-849-7580
Mailing Address - Fax:914-849-7555
Practice Address - Street 1:2 LONGVIEW AVE STE 400
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10601-5000
Practice Address - Country:US
Practice Address - Phone:914-849-7580
Practice Address - Fax:914-849-7555
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-20
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY318167-01208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery