Healthcare Provider Details

I. General information

NPI: 1548236938
Provider Name (Legal Business Name): DIANE GEORGE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2006
Last Update Date: 01/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3959 BROADWAY COLUMBIA UNIVERSITY DEPARTMENT PEDIATRIC
NEW YORK NY
10032-1559
US

IV. Provider business mailing address

3959 BROADWAY CHN 10-06
NEW YORK NY
10032-1559
US

V. Phone/Fax

Practice location:
  • Phone: 212-304-7250
  • Fax: 212-544-1974
Mailing address:
  • Phone: 212-305-9806
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number190829
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: