Basic Information
| Provider Information | |||||||||
| NPI: | 1427364637 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BARNICKEL | ||||||||
| FirstName: | DIANE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 175 FULTON AVE | ||||||||
| Address2: | SUITE 502 | ||||||||
| City: | HEMPSTEAD | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115503718 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5165656322 | ||||||||
| FaxNumber: | 5165656325 | ||||||||
| Practice Location | |||||||||
| Address1: | 175 FULTON AVE | ||||||||
| Address2: | SUITE 502 | ||||||||
| City: | HEMPSTEAD | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115503718 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5165656322 | ||||||||
| FaxNumber: | 5165656325 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/25/2010 | ||||||||
| LastUpdateDate: | 08/25/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164W00000X | 236283-1 | NY | Y | Nursing Service Providers | Licensed Practical Nurse |
ID Information
| ID | Type | State | Issuer | Description | 1750493706 | 05 | NY | MEDICAID |