Healthcare Provider Details

I. General information

NPI: 1942685698
Provider Name (Legal Business Name): DIANA ZAMORA PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2015
Last Update Date: 09/20/2021
Certification Date: 09/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 10TH AVE SUITE 2T
NEW YORK NY
10019-1147
US

IV. Provider business mailing address

1000 10TH AVE SUITE 2T
NEW YORK NY
10019-1147
US

V. Phone/Fax

Practice location:
  • Phone: 212-523-6500
  • Fax: 212-523-7182
Mailing address:
  • Phone: 212-523-6500
  • Fax: 212-523-7182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number35SI00593900
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY10471
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number021198
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: