MEDICARE: DR. DIANA VALCICH M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	249883	NY
2	390200000X	Student in an Organized Health Care Education/Training Program
3	207PS0010X	Sports Medicine (Emergency Medicine) Physician	249883	NY

General Provider Information

NPI Number	:	1487816393
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DIANA VALCICH M.D.

Provider Business Mailing Address
First Line	:	27005 76TH AVE
Second Line	:
City	:	NEW HYDE PARK
State	:	NY
Zip	:	11040-1402
Country	:	US
Telephone Number	:	718-470-7501
Fax Number	:

Provider Business Practice Location Address
First Line	:	201 COW NECK RD
Second Line	:
City	:	PORT WASHINGTON
State	:	NY
Zip	:	11050-1143
Country	:	US
Telephone Number	:	516-883-2444
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/01/2008
Last Update Date	:	06/20/2018

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