Provider Demographics
NPI:1851930069
Name:KROGMAN, DIANE
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:KROGMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 DEVON RD
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11717-2144
Mailing Address - Country:US
Mailing Address - Phone:631-434-2435
Mailing Address - Fax:631-434-2188
Practice Address - Street 1:2 DEVON RD
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:NY
Practice Address - Zip Code:11717-2144
Practice Address - Country:US
Practice Address - Phone:631-434-2435
Practice Address - Fax:631-434-2188
Is Sole Proprietor?:No
Enumeration Date:2020-01-06
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY582490-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse