Basic Information
| Provider Information | |||||||||
| NPI: | 1841787769 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DIANAT | ||||||||
| FirstName: | AZADEH | ||||||||
| MiddleName: | MAY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 225 BROADWAY STE 101 | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100073911 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2127327400 | ||||||||
| FaxNumber: | 2127320238 | ||||||||
| Practice Location | |||||||||
| Address1: | 760 BROADWAY RM 2C319 | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112065317 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7189638310 | ||||||||
| FaxNumber: | 7186303244 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/16/2018 | ||||||||
| LastUpdateDate: | 09/23/2019 | ||||||||
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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 | 1223G0001X | 060417 | NY | Y | Dental Providers | Dentist | General Practice |
No ID Information.