Provider Demographics
NPI:1407249816
Name:KIDERIS, DIANE (MS ED)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:KIDERIS
Suffix:
Gender:F
Credentials:MS ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 BARNUM AVE
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-6025
Mailing Address - Country:US
Mailing Address - Phone:917-865-2380
Mailing Address - Fax:
Practice Address - Street 1:43 BARNUM AVE
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-6025
Practice Address - Country:US
Practice Address - Phone:917-865-2380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-09
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1391140174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist