Healthcare Provider Details

I. General information

NPI: 1447256995
Provider Name (Legal Business Name): DIANE M CLAUSEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2005
Last Update Date: 08/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 N BELLE MEAD RD
E SETAUKET NY
11733-3456
US

IV. Provider business mailing address

1500 ROUTE 112 BLDG 4
PORT JEFFERSON STATION NY
11776-8055
US

V. Phone/Fax

Practice location:
  • Phone: 631-751-3000
  • Fax: 631-675-2001
Mailing address:
  • Phone: 631-751-3000
  • Fax: 631-675-2001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number186523
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: