Provider Demographics
NPI:1073683108
Name:STEPHEN G. DIAMANTONI MD AND ASSOCIATES FAMILY PRACTICE, P.C.
Entity Type:Organization
Organization Name:STEPHEN G. DIAMANTONI MD AND ASSOCIATES FAMILY PRACTICE, P.C.
Other - Org Name:RENEW PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:NEFF
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:717-390-9935
Mailing Address - Street 1:319 N DUKE ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17602-4930
Mailing Address - Country:US
Mailing Address - Phone:717-390-9935
Mailing Address - Fax:
Practice Address - Street 1:319 N DUKE ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17602-4930
Practice Address - Country:US
Practice Address - Phone:717-390-9935
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA158841OtherGROUP PRACTICE