Provider Demographics
NPI:1740329960
Name:WU, DIANA (RPAC)
Entity type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:
Last Name:WU
Suffix:
Gender:F
Credentials:RPAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 E 15TH ST
Mailing Address - Street 2:APT. 7L
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-3922
Mailing Address - Country:US
Mailing Address - Phone:917-453-0101
Mailing Address - Fax:212-746-5236
Practice Address - Street 1:525 E 68TH ST
Practice Address - Street 2:BOX 294
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-4870
Practice Address - Country:US
Practice Address - Phone:212-746-5294
Practice Address - Fax:212-746-5236
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004350363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant