Individual
DIANA GONGORA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
305 LENOX AVE, HARLEM HOSP., NEW YORK, NY 10037
(212) 939-1000
Mailing address
506 MALCOLM X BLVD, NEW YORK, NY 10037-1802
(212) 939-1000
Taxonomy
Speciality
Code
Description
License number
State
221700000X
Art Therapist
Primary
001279
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001279
—
NY
Enumeration date
03/29/2014
Last updated
07/12/2016
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