Provider Demographics
NPI:1033660675
Name:ZITSERMAN, DIANA (ND, LAC)
Entity Type:Individual
Prefix:DR
First Name:DIANA
Middle Name:
Last Name:ZITSERMAN
Suffix:
Gender:F
Credentials:ND, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:783 CHAMBERLAIN HWY
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:CT
Mailing Address - Zip Code:06037-1903
Mailing Address - Country:US
Mailing Address - Phone:215-896-6132
Mailing Address - Fax:
Practice Address - Street 1:10 COMMERCE ST STE A
Practice Address - Street 2:
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-4802
Practice Address - Country:US
Practice Address - Phone:860-266-7448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-19
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT580175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath