1851824007 NPI number — GRETCHEN GIOVANNA DE DIEGO CORNIER M.D.

Table of content: GRETCHEN GIOVANNA DE DIEGO CORNIER M.D. (NPI 1851824007)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851824007 NPI number — GRETCHEN GIOVANNA DE DIEGO CORNIER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DE DIEGO CORNIER
Provider First Name:
GRETCHEN
Provider Middle Name:
GIOVANNA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DE DIEGO
Provider Other First Name:
GRETCHEN
Provider Other Middle Name:
GIOVANNA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1851824007
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/07/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1111 AMSTERDAM AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10025-1716
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-523-3610
Provider Business Mailing Address Fax Number:
212-523-3609

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 10TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10019-1147
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-523-4000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/05/2017

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: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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