Healthcare Provider Details

I. General information

NPI: 1467438705
Provider Name (Legal Business Name): MS. DIANA SUSAN HURWITZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2005
Last Update Date: 08/10/2021
Certification Date: 08/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 DEARFIELD DR
GREENWICH CT
06831-5351
US

IV. Provider business mailing address

4 DEARFIELD DR STE 106
GREENWICH CT
06831-5351
US

V. Phone/Fax

Practice location:
  • Phone: 212-249-8884
  • Fax: 212-249-8884
Mailing address:
  • Phone: 212-249-8884
  • Fax: 212-249-8884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number020271
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: