Provider Demographics
NPI:1588020978
Name:RESKA, DIANA (VMD)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:RESKA
Suffix:
Gender:F
Credentials:VMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7383 MADISON ST
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13480-1911
Mailing Address - Country:US
Mailing Address - Phone:315-841-4021
Mailing Address - Fax:
Practice Address - Street 1:7383 MADISON ST
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:NY
Practice Address - Zip Code:13480-1911
Practice Address - Country:US
Practice Address - Phone:315-841-4021
Practice Address - Fax:315-841-4004
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-14
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013469174M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174M00000XOther Service ProvidersVeterinarian