Provider Demographics
NPI:1962499442
Name:GREGOROPOULOS, DIANA (DPM)
Entity Type:Individual
Prefix:DR
First Name:DIANA
Middle Name:
Last Name:GREGOROPOULOS
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:987 79TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11228-2613
Mailing Address - Country:US
Mailing Address - Phone:718-745-0554
Mailing Address - Fax:718-921-4603
Practice Address - Street 1:987 79TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11228-2613
Practice Address - Country:US
Practice Address - Phone:718-745-0554
Practice Address - Fax:718-921-4603
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004797213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU29381Medicare UPIN