Provider Demographics
NPI:1750540688
Name:MOGA, DIANA ELENA (MD,PHD, PC)
Entity type:Individual
Prefix:DR
First Name:DIANA
Middle Name:ELENA
Last Name:MOGA
Suffix:
Gender:F
Credentials:MD,PHD, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 W 82ND ST STE 1CD
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-5544
Mailing Address - Country:US
Mailing Address - Phone:468-310-3796
Mailing Address - Fax:866-586-5679
Practice Address - Street 1:139 W 82ND ST STE 1CD
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-5544
Practice Address - Country:US
Practice Address - Phone:468-310-3796
Practice Address - Fax:866-586-5679
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-05
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0034562084P0800X
NY2671892084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry