Provider Demographics
NPI:1699037655
Name:WEIDER, DIANE M
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:M
Last Name:WEIDER
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 1:691 SAINT PAUL ST FL 4
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14605-1706
Mailing Address - Country:US
Mailing Address - Phone:585-753-5250
Mailing Address - Fax:
Practice Address - Street 1:691 SAINT PAUL ST FL 4
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14605-1706
Practice Address - Country:US
Practice Address - Phone:585-753-5250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-14
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator