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General NPI Number Information
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NPI Number | 1336641653
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Entity Type | Individual
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Provider Name | DANIELLE DIETZEK FNP
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Gender | Female
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Dates
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Enumeration Date | 03/02/2018
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Last Update Date | 03/02/2018
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Provider Practice Location Address
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Address Line | 308 E 15TH ST # A
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City | NEW YORK
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State | NY
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Zip | 10003-4001
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Country | US
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Telephone | 212-420-6460
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Fax |
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Provider Business Mailing Address
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Address Line | 301 E 78TH ST APT 9A
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City | NEW YORK
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State | NY
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Zip | 10075-1327
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Country | US
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Telephone |
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Fax |
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 341510
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License Number State | NY
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