Provider Demographics
NPI:1801031018
Name:RANIERI, DIANE (PA)
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:
Last Name:RANIERI
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DEPT OF PA EDUC SCHOOL OF HLTH TECH AND MGMT
Mailing Address - Street 2:HSC L2 RM 425 STONY BROOK UNIVERSITY
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794-0001
Mailing Address - Country:US
Mailing Address - Phone:631-444-6132
Mailing Address - Fax:631-444-1404
Practice Address - Street 1:PC 815 HALLOCK AVE.
Practice Address - Street 2:SUITE A KIDS FIRST PEDIATRICS,
Practice Address - City:PORT JEFFERSON STATION
Practice Address - State:NY
Practice Address - Zip Code:11776-1244
Practice Address - Country:US
Practice Address - Phone:631-331-7267
Practice Address - Fax:631-331-7579
Is Sole Proprietor?:No
Enumeration Date:2008-12-03
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002743363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant