Provider Demographics
NPI:1629330360
Name:LEDESMA, DIANA
Entity Type:Individual
Prefix:MS
First Name:DIANA
Middle Name:
Last Name:LEDESMA
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 1:4826 44TH ST
Mailing Address - Street 2:APT 2E
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-6938
Mailing Address - Country:US
Mailing Address - Phone:845-264-8553
Mailing Address - Fax:
Practice Address - Street 1:825 W END AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-5349
Practice Address - Country:US
Practice Address - Phone:917-995-1016
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-08
Last Update Date:2012-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator