Provider Demographics
NPI:1912626441
Name:COLGAN, DIANA MARIE
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:MARIE
Last Name:COLGAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 COMMONS DR
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-5211
Mailing Address - Country:US
Mailing Address - Phone:173-256-7495
Mailing Address - Fax:
Practice Address - Street 1:8000 UTOPIA PKWY
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11439-9000
Practice Address - Country:US
Practice Address - Phone:718-390-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-26
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant