Provider Demographics
NPI:1780704205
Name:FINKEL, DIANA GUREVICH (DO)
Entity type:Individual
Prefix:DR
First Name:DIANA
Middle Name:GUREVICH
Last Name:FINKEL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:140 BERGEN STREET D LEVEL
Mailing Address - Street 2:AMBULATORY CARE CENTER
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07013-2425
Mailing Address - Country:US
Mailing Address - Phone:973-972-5111
Mailing Address - Fax:973-972-3102
Practice Address - Street 1:140 BERGEN STREET
Practice Address - Street 2:AMBULATORY CARE CENTER LEVEL D
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07103
Practice Address - Country:US
Practice Address - Phone:973-972-5111
Practice Address - Fax:973-972-3102
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MB07426000207R00000X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ25MB0742600OtherLICENSE
NJ4019103Medicaid
NJ4019103Medicaid
066650STMMedicare PIN
NJ066650Medicare ID - Type Unspecified