Healthcare Provider Details

I. General information

NPI: 1659556017
Provider Name (Legal Business Name): KLEONIKI DIAMANTIS ZROWKA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KLEONIKI DIAMANTIS NP

II. Dates (important events)

Enumeration Date: 01/04/2008
Last Update Date: 08/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1275 YORK AVE M-9
NEW YORK NY
10065-6007
US

IV. Provider business mailing address

1275 YORK AVE M-9
NEW YORK NY
10065-6007
US

V. Phone/Fax

Practice location:
  • Phone: 212-639-6911
  • Fax:
Mailing address:
  • Phone: 212-639-6911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF335054
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: