Provider Demographics
NPI:1235241597
Name:ADDIS, DIANA M (MD)
Entity Type:Individual
Prefix:DR
First Name:DIANA
Middle Name:M
Last Name:ADDIS
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:98 FORD RD
Mailing Address - Street 2:SUITE 3-H
Mailing Address - City:DENVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07834-1374
Mailing Address - Country:US
Mailing Address - Phone:973-625-3366
Mailing Address - Fax:973-625-0349
Practice Address - Street 1:89 SPARTA AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:SPARTA
Practice Address - State:NJ
Practice Address - Zip Code:07871-1777
Practice Address - Country:US
Practice Address - Phone:908-918-0001
Practice Address - Fax:908-918-0003
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2010-07-29
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA07065800208600000X, 2086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ093709PXGMedicare ID - Type UnspecifiedMEDICARE INDIVIDL PROVIDR
NJH70593Medicare UPIN