Provider Demographics
NPI:1932657681
Name:GOZIKER, DIANA (MS SLP)
Entity Type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:
Last Name:GOZIKER
Suffix:
Gender:F
Credentials:MS SLP
Other - Prefix:MS
Other - First Name:DIANA
Other - Middle Name:
Other - Last Name:SHTIVELMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS SLP
Mailing Address - Street 1:32 CHAPEL RD
Mailing Address - Street 2:
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030-3602
Mailing Address - Country:US
Mailing Address - Phone:917-498-1101
Mailing Address - Fax:
Practice Address - Street 1:329 E 149TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451-5601
Practice Address - Country:US
Practice Address - Phone:718-769-2698
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-12
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021712-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist