Individual
DIANA MOLLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
10201 66TH RD, NORTH SHORE- LIJ FOREST HILLS,, FOREST HILLS, NY 11375-2029
(718) 830-4000
Mailing address
34 N HENRY ST, VALLEY STREAM, NY 11580-1929
(516) 551-1071
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
018309-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
11-3465690
—
NY
Enumeration date
01/12/2015
Last updated
01/20/2015
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