Provider Demographics
NPI:1508960543
Name:NIESTEPSKI, DIANE MARIE (PA)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:MARIE
Last Name:NIESTEPSKI
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:376 LAFAYETTE RD
Mailing Address - Street 2:STE 202
Mailing Address - City:SPARTA
Mailing Address - State:NJ
Mailing Address - Zip Code:07871-3560
Mailing Address - Country:US
Mailing Address - Phone:908-684-3005
Mailing Address - Fax:908-684-3301
Practice Address - Street 1:653 WILLOW GROVE ST
Practice Address - Street 2:SUITE 2000
Practice Address - City:HACKETTSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07840-1732
Practice Address - Country:US
Practice Address - Phone:908-684-3005
Practice Address - Fax:908-684-3301
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00157300363A00000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical