Provider Demographics
NPI:1154449734
Name:GOLDBLUM-GRAFF, DIANE (MSN, APN, BC)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:GOLDBLUM-GRAFF
Suffix:
Gender:F
Credentials:MSN, APN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 NEW RD STE 405
Mailing Address - Street 2:
Mailing Address - City:LINWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08221-1283
Mailing Address - Country:US
Mailing Address - Phone:609-412-1717
Mailing Address - Fax:
Practice Address - Street 1:222 NEW RD STE 405
Practice Address - Street 2:
Practice Address - City:LINWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08221-1283
Practice Address - Country:US
Practice Address - Phone:609-412-1717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNJ00113400364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult