Provider Demographics
NPI:1528593340
Name:DIANE CATHERINE DEFILIPPO NURSE PRACTITIONER IN PSYCHIATRY PLLC
Entity Type:Organization
Organization Name:DIANE CATHERINE DEFILIPPO NURSE PRACTITIONER IN PSYCHIATRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:CATHERINE
Authorized Official - Last Name:DEFILIPPO
Authorized Official - Suffix:
Authorized Official - Credentials:MSN
Authorized Official - Phone:516-321-0966
Mailing Address - Street 1:126 E PARK AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-3510
Mailing Address - Country:US
Mailing Address - Phone:516-321-0966
Mailing Address - Fax:516-208-8430
Practice Address - Street 1:126 E PARK AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-3510
Practice Address - Country:US
Practice Address - Phone:516-321-0966
Practice Address - Fax:516-208-8430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-30
Last Update Date:2017-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY401781363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty