Provider Demographics
NPI:1184039893
Name:DEFILIPPO, DIANE C (NPP)
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:C
Last Name:DEFILIPPO
Suffix:
Gender:F
Credentials:NPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1034
Mailing Address - Street 2:101 EAST PARK AVE.
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-0962
Mailing Address - Country:US
Mailing Address - Phone:516-321-0966
Mailing Address - Fax:516-208-8430
Practice Address - Street 1:126 E PARK AVE
Practice Address - Street 2:LONG BEACH, NY
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-3510
Practice Address - Country:US
Practice Address - Phone:516-321-0966
Practice Address - Fax:516-208-8430
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-23
Last Update Date:2014-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF401781-1363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health