Healthcare Provider Details

I. General information

NPI: 1598847980
Provider Name (Legal Business Name): DIANE JAWORSKI PETITO CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 08/30/2022
Certification Date: 08/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 PRESIDENT ST HEMPSTEAD HIGH HEALTH CENTER
HEMPSTEAD NY
11550-4718
US

IV. Provider business mailing address

128 DUNWOODIE AVE
WEST ISLIP NY
11795-1934
US

V. Phone/Fax

Practice location:
  • Phone: 516-292-7111
  • Fax: 516-292-4651
Mailing address:
  • Phone: 631-422-4585
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number298429-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberF380742
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: