Provider Demographics
NPI:1316409907
Name:LENIS, DIANA
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:LENIS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 SMITH HAVEN MALL
Mailing Address - Street 2:SUITE 203
Mailing Address - City:LAKE GROVE
Mailing Address - State:NY
Mailing Address - Zip Code:11755-2508
Mailing Address - Country:US
Mailing Address - Phone:631-444-0580
Mailing Address - Fax:
Practice Address - Street 1:4 SMITH HAVEN MALL, SUITE 203
Practice Address - Street 2:
Practice Address - City:LAKE GROVE
Practice Address - State:NY
Practice Address - Zip Code:11755-0001
Practice Address - Country:US
Practice Address - Phone:631-444-0580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-02
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY316755207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine