| Doctor Name: | MS. DIANE J YASTRUB |
| NPI Number: | 1003802752 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | FNP |
| License Number: | F332974-1 |
| Business Practice Address: | 2 Cedar Ln Massapequa, NY - 117586618 |
| Business Phone Number: | 5163135563 |
| Business Fax Number: | 5168097500 |
| Mailing Address: | 2 Cedar Ln, MASSAPEQUA |
| State: | NY |
| Postal Code: | 117586618 |
| Phone Number: | 5163135563 |
| Fax Number: | 5168097500 |
| NPI Enumeration Date: | 09/27/2005 |
| NPI Last Update Date: | 07/19/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | F332974-1 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |