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General NPI Number Information
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NPI Number | 1003815556
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Entity Type | Individual
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Provider Name | DIANE DELUCA-PATWELL C-PED
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Gender | Female
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Dates
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Enumeration Date | 07/18/2005
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 400 MONTAUK HWY SUITE 113
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City | WEST ISLIP
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State | NY
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Zip | 11795-4429
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Country | US
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Telephone | 631-321-1666
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Fax | 631-321-1666
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Provider Business Mailing Address
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Address Line | 105 ARGYLE AVE
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City | BABYLON
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State | NY
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Zip | 11702-2600
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Country | US
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Telephone | 631-669-0721
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Fax | 631-539-4370
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171W00000X
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Taxonomy Name | Contractor
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License Number |
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License Number State |
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