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General NPI Number Information
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NPI Number | 1801031018
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Entity Type | Individual
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Provider Name | DIANE RANIERI PA
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Gender | Female
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Dates
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Enumeration Date | 12/03/2008
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Last Update Date | 12/03/2008
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Provider Practice Location Address
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Address Line | PC 815 HALLOCK AVE. SUITE A KIDS FIRST PEDIATRICS,
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City | PORT JEFFERSON STATION
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State | NY
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Zip | 11776-1244
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Country | US
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Telephone | 631-331-7267
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Fax | 631-331-7579
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Provider Business Mailing Address
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Address Line | DEPT OF PA EDUC SCHOOL OF HLTH TECH AND MGMT HSC L2 RM 425 STONY BROOK UNIVERSITY
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City | STONY BROOK
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State | NY
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Zip | 11794-0001
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Country | US
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Telephone | 631-444-6132
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Fax | 631-444-1404
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 002743
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License Number State | NY
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