Provider Demographics
NPI:1477215853
Name:MARISCA, DIANE
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:MARISCA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 DORSET CIR
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07006-6123
Mailing Address - Country:US
Mailing Address - Phone:845-893-0102
Mailing Address - Fax:
Practice Address - Street 1:24 DORSET CIR
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:NJ
Practice Address - Zip Code:07006-6123
Practice Address - Country:US
Practice Address - Phone:973-287-6336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-12
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care