1164622858 NPI number — DIANA WAXLER PA-C

Table of content: DIANA WAXLER PA-C (NPI 1164622858)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164622858 NPI number — DIANA WAXLER PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WAXLER
Provider First Name:
DIANA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164622858
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/29/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
800 WESTCHESTER AVE
Provider Second Line Business Mailing Address:
STE N715
Provider Business Mailing Address City Name:
RYE BROOK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10573-1369
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-607-5730
Provider Business Mailing Address Fax Number:
914-457-1195

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
210 WESTCHESTER AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WHITE PLAINS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10604-2901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-681-3100
Provider Business Practice Location Address Fax Number:
914-682-6588
Provider Enumeration Date:
07/20/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363AM0700X , with the licence number:  009985 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)