Provider Demographics
NPI:1396346250
Name:DIWNICH, NAZARIY (FNP)
Entity type:Individual
Prefix:
First Name:NAZARIY
Middle Name:
Last Name:DIWNICH
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:MR
Other - First Name:NAZARIY
Other - Middle Name:
Other - Last Name:DIWNICH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:80 ROSS ST APT 4D
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11249-7644
Mailing Address - Country:US
Mailing Address - Phone:347-330-2666
Mailing Address - Fax:
Practice Address - Street 1:517 PARK AVE
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11205-1783
Practice Address - Country:US
Practice Address - Phone:718-260-4600
Practice Address - Fax:718-260-4646
Is Sole Proprietor?:No
Enumeration Date:2020-11-05
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY346845363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily