Healthcare Provider Details

I. General information

NPI: 1457532723
Provider Name (Legal Business Name): MARIA D DIAZ NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2007
Last Update Date: 03/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 MALTESE DR
MIDDLETOWN NY
10940
US

IV. Provider business mailing address

111 MALTESE DRIVE
MIDDLETOWN NY
10940
US

V. Phone/Fax

Practice location:
  • Phone: 845-342-4774
  • Fax: 845-818-7555
Mailing address:
  • Phone: 845-342-4774
  • Fax: 845-818-7555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberF420537-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number423706
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number336990
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: