Healthcare Provider Details

I. General information

NPI: 1912907486
Provider Name (Legal Business Name): DIANE HOFFMAN CYMERMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2005
Last Update Date: 09/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 NESCONSET HWY 17-A
STONY BROOK NY
11790-2555
US

IV. Provider business mailing address

45 RESEARCH WAY SUITE 105
EAST SETAUKET NY
11733-6401
US

V. Phone/Fax

Practice location:
  • Phone: 631-751-6262
  • Fax: 631-751-6268
Mailing address:
  • Phone: 631-675-2125
  • Fax: 631-675-2624

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number161005
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: