Basic Information
Provider Information
NPI: 1003145699
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MARTIRE
FirstName: DIANE
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 160 RIVERSIDE BLVD
Address2: APT 10 M
City: NEW YORK
State: NY
PostalCode: 100690701
CountryCode: US
TelephoneNumber: 2127692207
FaxNumber:  
Practice Location
Address1: 160 RIVERSIDE BLVD
Address2: APT 10 M
City: NEW YORK
State: NY
PostalCode: 100690701
CountryCode: US
TelephoneNumber: 2127692207
FaxNumber:  
Other Information
ProviderEnumerationDate: 12/10/2009
LastUpdateDate: 12/10/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000XME69172FLN Allopathic & Osteopathic PhysiciansInternal Medicine 
207R00000XMA045328NJN Allopathic & Osteopathic PhysiciansInternal Medicine 
207R00000X159251NYY Allopathic & Osteopathic PhysiciansInternal Medicine 

No ID Information.


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