Provider Demographics
NPI:1093096679
Name:DIDISHEIM, ANDREA LOUISE (PTA)
Entity Type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:LOUISE
Last Name:DIDISHEIM
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 STATE RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-1300
Mailing Address - Country:US
Mailing Address - Phone:609-454-3536
Mailing Address - Fax:
Practice Address - Street 1:11 STATE RD
Practice Address - Street 2:SUITE 400
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-1300
Practice Address - Country:US
Practice Address - Phone:609-454-3536
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-08
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJPTA40QB00235800174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist