Provider Demographics
NPI:1437186962
Name:DIERMAYR, GUDRUN (PT)
Entity Type:Individual
Prefix:MS
First Name:GUDRUN
Middle Name:
Last Name:DIERMAYR
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355 W 52ND ST FL 7
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-6239
Mailing Address - Country:US
Mailing Address - Phone:646-778-5550
Mailing Address - Fax:646-778-5548
Practice Address - Street 1:355 W 52ND ST FL 7
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-6239
Practice Address - Country:US
Practice Address - Phone:646-778-5550
Practice Address - Fax:646-778-5548
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5503869OtherCERTIFICATION NUMBER
NY027622OtherLICENSE