Healthcare Provider Details

I. General information

NPI: 1164622858
Provider Name (Legal Business Name): DIANA WAXLER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2007
Last Update Date: 07/29/2021
Certification Date: 07/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 WESTCHESTER AVE
WHITE PLAINS NY
10604-2901
US

IV. Provider business mailing address

800 WESTCHESTER AVE STE N715
RYE BROOK NY
10573-1369
US

V. Phone/Fax

Practice location:
  • Phone: 914-681-3100
  • Fax: 914-682-6588
Mailing address:
  • Phone: 914-607-5730
  • Fax: 914-457-1195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number009985
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: