Provider Demographics
NPI:1316003841
Name:DIAMENT, MELYSA (OT)
Entity Type:Individual
Prefix:
First Name:MELYSA
Middle Name:
Last Name:DIAMENT
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 E 23RD ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-4606
Mailing Address - Country:US
Mailing Address - Phone:212-683-4288
Mailing Address - Fax:212-686-0905
Practice Address - Street 1:220 E 23RD ST
Practice Address - Street 2:SUITE 200
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-4606
Practice Address - Country:US
Practice Address - Phone:212-683-4288
Practice Address - Fax:212-686-0905
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010428225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQT2841Medicare ID - Type Unspecified