Provider Demographics
NPI:1295369023
Name:DIABETICWATCHERS USA LLC
Entity Type:Organization
Organization Name:DIABETICWATCHERS USA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MILA
Authorized Official - Middle Name:
Authorized Official - Last Name:CORRAO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-577-8994
Mailing Address - Street 1:30 GALESI DR STE 104B
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-4840
Mailing Address - Country:US
Mailing Address - Phone:201-577-8994
Mailing Address - Fax:
Practice Address - Street 1:315 W 36TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10018-6404
Practice Address - Country:US
Practice Address - Phone:844-277-5066
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DIABETICWATCHERS USA LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-03-02
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0904XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, Federal
No251K00000XAgenciesPublic Health or Welfare
No251S00000XAgenciesCommunity/Behavioral Health
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No261QC1800XAmbulatory Health Care FacilitiesClinic/CenterCorporate Health
No261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
No302R00000XManaged Care OrganizationsHealth Maintenance Organization