Healthcare Provider Details

I. General information

NPI: 1669712113
Provider Name (Legal Business Name): DIANA BRATESH SKORNICKI M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2013
Last Update Date: 02/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 E 68TH ST APT 7C
NEW YORK NY
10065-5844
US

IV. Provider business mailing address

20 E 68TH ST APT 7C
NEW YORK NY
10065-5844
US

V. Phone/Fax

Practice location:
  • Phone: 516-776-1790
  • Fax:
Mailing address:
  • Phone: 516-766-1790
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number1650341
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: