Provider Demographics
NPI:1144423153
Name:FIUMARA, DIANE (DDS)
Entity Type:Individual
Prefix:DR
First Name:DIANE
Middle Name:
Last Name:FIUMARA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 SEMINOLE DR
Mailing Address - Street 2:
Mailing Address - City:MORGANVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07751-4641
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:281 SUMMERHILL RD
Practice Address - Street 2:SUITE 203
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-4270
Practice Address - Country:US
Practice Address - Phone:732-257-7759
Practice Address - Fax:732-257-8043
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI020402001223G0001X
NY0451131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0090620Medicaid
NJ0066877Medicaid