Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | N004506 | NY |
N | 222Z00000X | Podiatrist | N004506 | NY |
NPI | 1003974684 |
---|---|
Provider Name | Diana Matta |
First Address | Chestnut Ridge, NY 10977 |
Second Address | New York, NY 10037 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2006 |
Last Update Date | 10/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01128578 | (05) | NY |
T81561 | (02) | NY |