Provider Demographics
NPI:1245238294
Name:TRUSKY, DIANA (MD)
Entity Type:Individual
Prefix:DR
First Name:DIANA
Middle Name:
Last Name:TRUSKY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:92 HALF MILE RD
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-5638
Mailing Address - Country:US
Mailing Address - Phone:732-219-0700
Mailing Address - Fax:732-224-0750
Practice Address - Street 1:92 HALF MILE RD
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-5638
Practice Address - Country:US
Practice Address - Phone:732-219-0700
Practice Address - Fax:732-224-0750
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-13
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA37523174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ806686Medicare PIN