Provider Demographics
NPI:1386804789
Name:GARRETTO, DIANA JANET (MD)
Entity type:Individual
Prefix:DR
First Name:DIANA
Middle Name:JANET
Last Name:GARRETTO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1554
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-0988
Mailing Address - Country:US
Mailing Address - Phone:631-444-0650
Mailing Address - Fax:631-638-4170
Practice Address - Street 1:6 TECHNOLOGY DRIVE
Practice Address - Street 2:SUITE 200
Practice Address - City:SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-9254
Practice Address - Country:US
Practice Address - Phone:631-444-4686
Practice Address - Fax:631-444-4622
Is Sole Proprietor?:No
Enumeration Date:2008-06-10
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY265210207VM0101X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program