Provider Demographics
NPI:1578161832
Name:MALONEY, DIANA L (PNP-BC)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:L
Last Name:MALONEY
Suffix:
Gender:F
Credentials:PNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:159 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:VALLEY COTTAGE
Mailing Address - State:NY
Mailing Address - Zip Code:10989-2467
Mailing Address - Country:US
Mailing Address - Phone:845-499-4842
Mailing Address - Fax:
Practice Address - Street 1:219 EVERETT AVE
Practice Address - Street 2:
Practice Address - City:WYCKOFF
Practice Address - State:NJ
Practice Address - Zip Code:07481-1904
Practice Address - Country:US
Practice Address - Phone:201-891-4777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-09
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01059600163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics