Provider Demographics
NPI:1700368875
Name:MAMUT, DIANE MARIE (HIS)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:MARIE
Last Name:MAMUT
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 ROUTE 46 STE G51
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN LAKES
Mailing Address - State:NJ
Mailing Address - Zip Code:07046-1676
Mailing Address - Country:US
Mailing Address - Phone:973-588-7266
Mailing Address - Fax:973-588-7268
Practice Address - Street 1:134 W MIDDLE ST STE A
Practice Address - Street 2:
Practice Address - City:CHELSEA
Practice Address - State:MI
Practice Address - Zip Code:48118-1515
Practice Address - Country:US
Practice Address - Phone:734-475-9109
Practice Address - Fax:734-475-7080
Is Sole Proprietor?:No
Enumeration Date:2018-09-05
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter