Individual
DR. DIANAH THELMA LAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1400 PELHAM PKWY S, BRONX, NY 10461-1138
(718) 918-5820
Mailing address
8 LEO TER, BLOOMFIELD, NJ 07003-4414
(917) 334-2381
(973) 338-1041
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
25MA08177800
NJ
207P00000X
Emergency Medicine Physician
MD21481
ME
Other
Enumeration date
01/30/2007
Last updated
05/04/2017
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