Individual
FARAH DIVERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
25953 148TH RD, ROSEDALE, NY 11422-2903
(917) 657-6511
Mailing address
25953 148TH RD, ROSEDALE, NY 11422-2903
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
F342209-1
NY
Other
Enumeration date
11/25/2017
Last updated
11/25/2017
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