Provider Demographics
NPI:1053710962
Name:DENISOVA, DIANA
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:DENISOVA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:
Other - Last Name:DENISOVA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:135 SEA BREEZE AVE
Mailing Address - Street 2:APT 205
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11224-3700
Mailing Address - Country:US
Mailing Address - Phone:917-848-3128
Mailing Address - Fax:
Practice Address - Street 1:135 SEA BREEZE AVE
Practice Address - Street 2:APT 205
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11224-3700
Practice Address - Country:US
Practice Address - Phone:917-848-3128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-15
Last Update Date:2014-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF306811363LA2200X
NYF340939363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology