Provider Demographics
NPI:1538151444
Name:INFANTINE-VYCE, DIANE M (DPM)
Entity type:Individual
Prefix:DR
First Name:DIANE
Middle Name:M
Last Name:INFANTINE-VYCE
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:DR
Other - First Name:DIANE
Other - Middle Name:M
Other - Last Name:INFANTINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:PO BOX 926
Mailing Address - Street 2:
Mailing Address - City:GUILDERLAND
Mailing Address - State:NY
Mailing Address - Zip Code:12084-0926
Mailing Address - Country:US
Mailing Address - Phone:518-869-8821
Mailing Address - Fax:518-869-8852
Practice Address - Street 1:5 NEW KARNER RD
Practice Address - Street 2:STE 6
Practice Address - City:GUILDERLAND
Practice Address - State:NY
Practice Address - Zip Code:12084-9511
Practice Address - Country:US
Practice Address - Phone:518-869-8821
Practice Address - Fax:518-869-8852
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005301-1213E00000X, 213EP1101X, 213ES0000X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Not Answered213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Not Answered213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine
Not Answered213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
U74075Medicare UPIN