Provider Demographics
NPI:1669533766
Name:TRAQUINA, DIANA N (MD)
Entity type:Individual
Prefix:DR
First Name:DIANA
Middle Name:N
Last Name:TRAQUINA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:181 SOMERSET ST
Mailing Address - Street 2:
Mailing Address - City:NEW BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08901-1946
Mailing Address - Country:US
Mailing Address - Phone:732-247-2401
Mailing Address - Fax:732-247-6920
Practice Address - Street 1:181 SOMERSET ST
Practice Address - Street 2:
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-1946
Practice Address - Country:US
Practice Address - Phone:732-247-2401
Practice Address - Fax:732-247-6920
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2010-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA68506207YP0228X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YP0228XAllopathic & Osteopathic PhysiciansOtolaryngologyPediatric Otolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8868409Medicaid
NJE53400Medicare UPIN
NJ8868409Medicaid