1225283278 NPI number — DR. DIANE MICHELE DITUSA D.O., M.P.H.

Table of content: DR. DIANE MICHELE DITUSA D.O., M.P.H. (NPI 1225283278)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225283278 NPI number — DR. DIANE MICHELE DITUSA D.O., M.P.H.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DITUSA
Provider First Name:
DIANE
Provider Middle Name:
MICHELE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O., M.P.H.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225283278
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/19/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2671 HIGHWAY 70
Provider Second Line Business Mailing Address:
WALL TOWNSHIP
Provider Business Mailing Address City Name:
MANASQUAN
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08736-2605
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-528-6999
Provider Business Mailing Address Fax Number:
732-528-3397

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2671 HIGHWAY 70
Provider Second Line Business Practice Location Address:
WALL TOWNSHIP
Provider Business Practice Location Address City Name:
MANASQUAN
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08736-2605
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-528-6999
Provider Business Practice Location Address Fax Number:
732-528-3397
Provider Enumeration Date:
11/18/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  25MB09079500 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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