Healthcare Provider Details

I. General information

NPI: 1629366372
Provider Name (Legal Business Name): BARRY LAWRENCE DIENER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2011
Last Update Date: 06/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 TECHNOLOGY DR
EAST SETAUKET NY
11733-4080
US

IV. Provider business mailing address

PO BOX 1559
STONY BROOK NY
11790-0989
US

V. Phone/Fax

Practice location:
  • Phone: 631-444-8340
  • Fax: 631-444-6045
Mailing address:
  • Phone: 631-444-8014
  • Fax: 631-444-6045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License NumberMD441936
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number274091
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: