Most Relevant Information
Provider Data
| NPI Number: | 1003815556 |
| Provider Name: | DIANE DELUCA-PATWELL C-PED |
| Entity Type: | Individual |
| Taxonomy Code: | 171W00000X |
| Specialty: | Contractor |
| License Number: |
Most Important Dates
| Enumeration Date: | 07/18/2005 |
| Last Updated: | 07/09/2007 |
Provider Practice Location
400 MONTAUK HWY
SUITE 113
WEST ISLIP
NY
117954429
Practice Location Phone/Fax
| Phone: | 6313211666 |
| Fax: | 6313211666 |
Provider Mailing Location
105 ARGYLE AVE
BABYLON
NY
117022600
Provider Mailing Phone/Fax
| Phone: | 6316690721 |
| Fax: | 6315394370 |