Healthcare Provider Details

I. General information

NPI: 1609242510
Provider Name (Legal Business Name): DIANA NICOLE KIRKE BSC MBBS MPHIL FRACS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2015
Last Update Date: 10/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 W 59TH ST FL 10
NEW YORK NY
10019-8022
US

IV. Provider business mailing address

425 W 59TH ST FL 10
NEW YORK NY
10019-8022
US

V. Phone/Fax

Practice location:
  • Phone: 212-262-4444
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number265097
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number291393
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: