Healthcare Provider Details

I. General information

NPI: 1952380578
Provider Name (Legal Business Name): DIANE KERSTEIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2006
Last Update Date: 10/31/2022
Certification Date: 10/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

666 LEXINGTON AVE STE 111
MOUNT KISCO NY
10549-3638
US

IV. Provider business mailing address

PO BOX 32103
NEW YORK NY
10087-2103
US

V. Phone/Fax

Practice location:
  • Phone: 914-864-1441
  • Fax:
Mailing address:
  • Phone: 914-864-1441
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number173911
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: