Healthcare Provider Details

I. General information

NPI: 1740298611
Provider Name (Legal Business Name): DIANN G ANTHONY DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 05/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23408 MERRICK BLVD
ROSEDALE NY
11422-1320
US

IV. Provider business mailing address

30 DEVON ROAD
HEMPSTEAD NY
11550
US

V. Phone/Fax

Practice location:
  • Phone: 718-527-0366
  • Fax:
Mailing address:
  • Phone: 718-527-0366
  • Fax: 718-527-0377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberN005551
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: