Provider Demographics
NPI:1962776070
Name:GASPARRO, DIANA LUCIA (RPA-C)
Entity type:Individual
Prefix:MISS
First Name:DIANA
Middle Name:LUCIA
Last Name:GASPARRO
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:MRS
Other - First Name:DIANA
Other - Middle Name:LUCIA
Other - Last Name:GASPARRO-ZUCCONI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPA-C
Mailing Address - Street 1:54 MOBREY LN
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-4294
Mailing Address - Country:US
Mailing Address - Phone:631-523-2293
Mailing Address - Fax:
Practice Address - Street 1:100 HOSPITAL RD
Practice Address - Street 2:SUITE #216
Practice Address - City:E PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-8809
Practice Address - Country:US
Practice Address - Phone:631-475-5511
Practice Address - Fax:631-475-5544
Is Sole Proprietor?:No
Enumeration Date:2012-03-07
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015340363A00000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical