Healthcare Provider Details

I. General information

NPI: 1598965766
Provider Name (Legal Business Name): DIANA VOSKOBOYNIK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2007
Last Update Date: 01/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 PELHAM PKWY S
BRONX NY
10461-1138
US

IV. Provider business mailing address

1400 PELHAM PKWY S DEPARTMENT OF PEDIATRIC EMERGENCY MEDICINE
BRONX NY
10461-1138
US

V. Phone/Fax

Practice location:
  • Phone: 718-918-5826
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA97715
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number235939
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number256286
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: