Basic Information
| Provider Information | |||||||||
| NPI: | 1194945113 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RAMANUJAM | ||||||||
| FirstName: | DIANA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 259 1ST ST | ||||||||
| Address2: | WINTHROP UNIVERSITY HOSPITAL TCV | ||||||||
| City: | MINEOLA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115013957 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5166632384 | ||||||||
| FaxNumber: | 5166638288 | ||||||||
| Practice Location | |||||||||
| Address1: | 259 1ST ST | ||||||||
| Address2: | WINTHROP UNIVERSITY HOSPITAL TCV | ||||||||
| City: | MINEOLA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115013957 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5166632384 | ||||||||
| FaxNumber: | 5166638288 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/01/2007 | ||||||||
| LastUpdateDate: | 09/08/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/08/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AS0400X | 009654-1 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
No ID Information.