Provider Demographics
NPI:1588863344
Name:CROCIATA, DIANE PATRICIA (RN)
Entity type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:PATRICIA
Last Name:CROCIATA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:DIANE
Other - Middle Name:PATRICIA
Other - Last Name:MACGREGOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:210 WEEKS AVE
Mailing Address - Street 2:
Mailing Address - City:MANORVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11949
Mailing Address - Country:US
Mailing Address - Phone:631-828-2818
Mailing Address - Fax:
Practice Address - Street 1:1 ST JOHNS RD
Practice Address - Street 2:
Practice Address - City:HAMPTON BAYS
Practice Address - State:NY
Practice Address - Zip Code:11946
Practice Address - Country:US
Practice Address - Phone:631-379-7454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-12
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4824371163W00000X, 163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WP0200XNursing Service ProvidersRegistered NursePediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02021685Medicaid