Healthcare Provider Details

I. General information

NPI: 1700808557
Provider Name (Legal Business Name): DIANA MARIE FELLIN CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

56-45 MAIN ST NEW YORK HOSPITAL MEDICAL CENTER OF QUEENS EMERGENCY D
FLUSHING NY
11355
US

IV. Provider business mailing address

PO BOX 430 EMERGENCY PRACTICE PLAN
FLUSHING NY
11352
US

V. Phone/Fax

Practice location:
  • Phone: 718-670-1231
  • Fax: 610-617-6280
Mailing address:
  • Phone: 610-668-6491
  • Fax: 610-617-6280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberF381269
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: