1962776070 NPI number — MISS DIANA LUCIA GASPARRO RPA-C

Table of content: MISS DIANA LUCIA GASPARRO RPA-C (NPI 1962776070)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962776070 NPI number — MISS DIANA LUCIA GASPARRO RPA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GASPARRO
Provider First Name:
DIANA
Provider Middle Name:
LUCIA
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
RPA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GASPARRO-ZUCCONI
Provider Other First Name:
DIANA
Provider Other Middle Name:
LUCIA
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
RPA-C
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1962776070
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/04/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
54 MOBREY LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SMITHTOWN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11787-4294
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-523-2293
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 HOSPITAL RD
Provider Second Line Business Practice Location Address:
SUITE #216
Provider Business Practice Location Address City Name:
E PATCHOGUE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11772-8809
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-475-5511
Provider Business Practice Location Address Fax Number:
631-475-5544
Provider Enumeration Date:
03/07/2012

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: 363A00000X , with the licence number:  015340 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363AS0400X , with the licence number: 015340 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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