Healthcare Provider Details

I. General information

NPI: 1083995906
Provider Name (Legal Business Name): DIANA GISSELL DINZEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2011
Last Update Date: 02/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

762 BRADY AVE APT. 529
BRONX NY
10462-2760
US

IV. Provider business mailing address

762 BRADY AVE APT. 529
BRONX NY
10462-2760
US

V. Phone/Fax

Practice location:
  • Phone: 646-202-0176
  • Fax:
Mailing address:
  • Phone: 646-202-0176
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: