Provider Demographics
NPI:1437556909
Name:CIPULLO, DIANA M (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:DIANA
Middle Name:M
Last Name:CIPULLO
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:
Other - Last Name:BERARDI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1377 MOTOR PKWY STE 307
Mailing Address - Street 2:
Mailing Address - City:ISLANDIA
Mailing Address - State:NY
Mailing Address - Zip Code:11749-5258
Mailing Address - Country:US
Mailing Address - Phone:914-294-4586
Mailing Address - Fax:631-760-8306
Practice Address - Street 1:725 NJ-15 #103
Practice Address - Street 2:
Practice Address - City:LAKE HOPATCONG
Practice Address - State:NJ
Practice Address - Zip Code:07849
Practice Address - Country:US
Practice Address - Phone:973-288-9110
Practice Address - Fax:973-943-4838
Is Sole Proprietor?:No
Enumeration Date:2014-11-29
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01586900225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist