MEDICARE: DIANA M MONCAYO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1376898692
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANA M MONCAYO

Provider Business Mailing Address
First Line	:	27 SIMMONS LN
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314-4721
Country	:	US
Telephone Number	:	917-200-5985
Fax Number	:	718-816-3488

Provider Business Practice Location Address
First Line	:	27 SIMMONS LN
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314-4721
Country	:	US
Telephone Number	:	917-200-5985
Fax Number	:	718-816-3488

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/24/2012
Last Update Date	:	07/24/2012

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Directions to “ DIANA M MONCAYO ” Practice Location

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