Provider Demographics
NPI:1225283278
Name:DITUSA, DIANE MICHELE (DO, MPH)
Entity Type:Individual
Prefix:DR
First Name:DIANE
Middle Name:MICHELE
Last Name:DITUSA
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Gender:F
Credentials:DO, MPH
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Mailing Address - Street 1:2671 HIGHWAY 70
Mailing Address - Street 2:WALL TOWNSHIP
Mailing Address - City:MANASQUAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08736-2605
Mailing Address - Country:US
Mailing Address - Phone:732-528-6999
Mailing Address - Fax:732-528-3397
Practice Address - Street 1:2671 HIGHWAY 70
Practice Address - Street 2:WALL TOWNSHIP
Practice Address - City:MANASQUAN
Practice Address - State:NJ
Practice Address - Zip Code:08736-2605
Practice Address - Country:US
Practice Address - Phone:732-528-6999
Practice Address - Fax:732-528-3397
Is Sole Proprietor?:No
Enumeration Date:2008-11-18
Last Update Date:2013-08-19
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Provider Licenses
StateLicense IDTaxonomies
NJ25MB09079500207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology