Individual
DIANA GENNARO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHYSICIAN ASSISTANT
Contact information
Practice address
111 E 210TH ST, BRONX, NY 10467-2401
(718) 920-2985
Mailing address
75 MOUNTAINSIDE DR, CHESTER, NY 10918-1419
(845) 238-5878
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
011993
NY
Other
Enumeration date
08/29/2007
Last updated
01/03/2017
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