DR. DIANE A BOURKE (NPI# 1124082375) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1124082375 |
| Entity Type | Individual |
| Full Name | DR. DIANE A BOURKE |
| Credential | M.D. |
| Practice Address |
7b Johnson Rd Latham NY 12110-3003 |
| Mailing Address |
711 Troy Schenectady Rd Ste 203 Latham NY 12110-2461 |
| Practice Telephone | 5187827733 |
| Practice Fax Number | 5187820800 |
| Mailing Telephone | 5187823700 |
| Mailing Fax Number | 5187823799 |
| Enumeration Date | 2006-04-14 |
| Last Update Date | 2018-01-18 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 174400000X | Specialist | 173530 | NY | Other Service Providers |
| Y | 2080P0006X |
Pediatrics Specialization: Developmental – Behavioral Pediatrics |
173530 | NY | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NY | GHI/HMO | 143257 | 01 |
| NY | EMPIRE BLUECROSS | 042ZE1 | 01 |
| NY | 01820997 | 05 | |
| NY | FIDELIS | 091231000203 | 01 |
| NY | CDPHP | PRC110027743 | 01 |
| NY | AETNA | 5780670 | 01 |
| NY | MVP HELATHCARE | 9042526 | 01 |
| Street Address |
7B JOHNSON RD |
| City | LATHAM |
| State | NY |
| Zip Code | 12110-3003 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992774780 | Catherine Canary | Pediatrics | 7b Johnson Rd, Latham, NY 12110-3003 | 2006-03-15 |
| 1063987915 | April Marie St. Peter | Nurse Practitioner | 7b Johnson Rd, Latham, NY 12110-3003 | 2018-10-08 |
| 1811478191 | Matthew Thomas Hickling | Nurse Practitioner | 7b Johnson Rd, Latham, NY 12110-3003 | 2018-08-24 |
| 1831615772 | Maude A Kaye | Nurse Practitioner | 7b Johnson Rd, Latham, NY 12110-3003 | 2017-08-22 |
| 1558886457 | Cheyenne Mackenzie Douglas | Nurse Practitioner | 7b Johnson Rd, Latham, NY 12110-3003 | 2017-08-11 |
| 1922451863 | Jillian Elyse Herrington | Nurse Practitioner | 7b Johnson Rd, Latham, NY 12110-3003 | 2016-07-15 |
| 1164704136 | Community Care Physicians, PC | Pediatrics | 7b Johnson Rd, Latham, NY 12110-3003 | 2011-09-15 |
| 1962638965 | Daniel Greenblatt | Pediatrics | 7b Johnson Rd, Latham, NY 12110-3003 | 2009-06-04 |
| 1124266606 | Donna Ann Riccio | Specialist | 7b Johnson Rd, Latham, NY 12110-3003 | 2009-01-22 |
| 1831337310 | Linda Lee Gaidusek | Registered Nurse | 7b Johnson Rd, Latham, NY 12110-3003 | 2009-01-22 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154963973 | Bayley Archinal | Physical Therapist | 711 Troy-schenectady Road, Ste 216, Latham, NY 12110 | 2019-10-14 |
| 1114410701 | Kimberly A. Hostig Licensed Clinical Social Worker Pllc | Clinic/Center | 8 Stanley Cir Ste 11, Latham, NY 12110 | 2018-06-08 |
| 1710477260 | Colleen Phillips | Physical Therapist | 711 Troy Schenectady Rd Ste 216, Latham, NY 12110 | 2018-05-10 |
| 1528574779 | Deborah Cannon | Specialist | 33c Waterford Avenue East, Latham, NY 12110 | 2017-12-26 |
| 1730600149 | Michael Navarrete | Dentist | 231 Wade Road Ext Unit 101, Latham, NY 12110 | 2017-07-06 |
| 1316499452 | Colonie Asc LLC | Clinic/Center | 207 Troy-schenectady Rd, Colonie, NY 12110 | 2016-10-25 |
| 1720539950 | Tania M Durante | Pharmacist | 1057 Troy-schenectady Rd, Latham, NY 12110 | 2016-10-24 |
| 1417344987 | New York Epilepsy Medicine, PC | Clinic/Center | 3 Lear Jet Ln Ste 203, Latham, NY 12110 | 2015-04-22 |
| 1346664752 | Lauren Gannon | Registered Nurse | 95 Forts Ferry Road, Latham, NY 12110 | 2014-02-06 |
| 1649522756 | Natasha Kapsaroff-ruiz | Nurse Practitioner | 654 Watervliet Shaker Rd, Latham, NY 12110 | 2012-10-12 |
| Find all providers in zip 12110 | ||||
| Taxonomy Code | 2080P0006X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| Specialization | Developmental – Behavioral Pediatrics |
| A developmental-behavioral specialist is a pediatrician with special training and experience who aims to foster understanding and promotion of optimal development of children and families through research, education, clinical care and advocacy efforts. This physician assists in the prevention, diagnosis, and management of developmental difficulties and problematic behaviors in children and in the family dysfunctions that compromise children's development. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition changed, source changed, 3/26/2008: definition corrected] Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992774780 | Catherine Canary | Pediatrics | 7b Johnson Rd, Latham, NY 12110-3003 | 2006-03-15 |
| 1164704136 | Community Care Physicians, PC | Pediatrics | 7b Johnson Rd, Latham, NY 12110-3003 | 2011-09-15 |
| 1730138330 | Micaela Nordhauser | Pediatrics | 7b Johnson Rd, Latham, NY 12110-3003 | 2006-05-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336746403 | Four Boroughs Aba | Pediatrics | 1344 E 24th St, Brooklyn, NY 11210-5143 | 2020-10-02 |
| 1447881735 | Jihee Chae | Pediatrics | 60 Wishing Ln, Hicksville, NY 11801-6423 | 2020-01-27 |
| 1235693730 | Sally Joanne Marotta Reed | Pediatrics | 5292 Cambria Rd, Sanborn, NY 14132-9412 | 2019-01-29 |
| 1063982817 | Jessica Elizabeth Sapio | Pediatrics | 125 Currier Ave, Sloan, NY 14212-2222 | 2018-12-04 |
| 1093293037 | Apf Therapeutic Services Inc | Pediatrics | 918 E 218th St Fl 1, Bronx, NY 10469-1006 | 2018-08-01 |
| 1679003552 | Lauren Jennifer Elchonen | Pediatrics | 18 N Cheryl St, Spring Valley, NY 10977-6510 | 2017-06-14 |
| 1295107183 | Spandana Nallapati | Pediatrics | 1510 Lexington Ave Apt 4n, New York, NY 10029-7154 | 2015-10-30 |
| 1275802811 | Icahn School of Medicine At Mount Sinai | Pediatrics | 500 7th Ave Fl 8, New York, NY 10018-4502 | 2011-12-28 |
| 1770870040 | Aleeya Healey | Pediatrics | 391 Myrtle Ave Ste 3b, Albany, NY 12208-3835 | 2011-07-07 |
| 1205045309 | Bharati R Shah | Pediatrics | 9 Wilbur Rd, Hudson Valley Ddso, Thiells, NY 10984-0470 | 2007-05-22 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.