Provider Demographics
NPI:1558333609
Name:DAZA LESMES, DIANA
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:DAZA LESMES
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 1:1578 WILLIAMSBRIDGE RD
Mailing Address - Street 2:SUITE 3D
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-6265
Mailing Address - Country:US
Mailing Address - Phone:718-863-3292
Mailing Address - Fax:718-863-3290
Practice Address - Street 1:1578 WILLIAMSBRIDGE RD
Practice Address - Street 2:SUITE 3D
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-6265
Practice Address - Country:US
Practice Address - Phone:718-863-3292
Practice Address - Fax:718-863-3290
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014929225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000000092285OtherGHI HMO
NY804723OtherTHE EMPIRE PLAN
NY203093066Other1199
NY203093066-001OtherHEALTH FIRST
NY3020978OtherMAGNACARE
NY6696925OtherGHI PPO/ CBP
NY014929OtherHIP
NY02662733Medicaid
NYQ28G4OtherEMPIRE BC BS
NYQP9861Medicare ID - Type Unspecified