Provider Demographics
NPI:1093969131
Name:LOMONTE, DIANA
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:LOMONTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195-10H 67TH AVE.
Mailing Address - Street 2:
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11365-3973
Mailing Address - Country:US
Mailing Address - Phone:347-834-4543
Mailing Address - Fax:
Practice Address - Street 1:438 GRAHAM AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11211-1415
Practice Address - Country:US
Practice Address - Phone:347-834-4543
Practice Address - Fax:718-389-4015
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-14
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY129950-1225100000X
NY029950-12251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist