Provider Demographics
NPI:1114579745
Name:MERKOVSKY, DIANE
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:MERKOVSKY
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 1:88 W MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:DUMONT
Mailing Address - State:NJ
Mailing Address - Zip Code:07628-2907
Mailing Address - Country:US
Mailing Address - Phone:201-562-7342
Mailing Address - Fax:
Practice Address - Street 1:88 W MADISON AVE
Practice Address - Street 2:
Practice Address - City:DUMONT
Practice Address - State:NJ
Practice Address - Zip Code:07628-2907
Practice Address - Country:US
Practice Address - Phone:201-562-7342
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-13
Last Update Date:2019-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath