Provider Demographics
NPI:1427185487
Name:ELIGON, DIANKAH T (MS, PT)
Entity Type:Individual
Prefix:
First Name:DIANKAH
Middle Name:T
Last Name:ELIGON
Suffix:
Gender:F
Credentials:MS, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13111 KEW GARDENS RD APT 5O
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:NY
Mailing Address - Zip Code:11418-1942
Mailing Address - Country:US
Mailing Address - Phone:646-552-9021
Mailing Address - Fax:
Practice Address - Street 1:131-11 KEW GARDENS RD APT 5O
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:NY
Practice Address - Zip Code:11418-1935
Practice Address - Country:US
Practice Address - Phone:646-552-9021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01153500225100000X
NY027599225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist