Provider Demographics
NPI:1710307228
Name:AILEY, DIANE (LAC)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:AILEY
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 STRAUBE CENTER BLVD
Mailing Address - Street 2:SUITE K 6/7
Mailing Address - City:PENNINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08534-1450
Mailing Address - Country:US
Mailing Address - Phone:609-954-5166
Mailing Address - Fax:
Practice Address - Street 1:114 STRAUBE CENTER BLVD
Practice Address - Street 2:SUITE K 6/7
Practice Address - City:PENNINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08534-1450
Practice Address - Country:US
Practice Address - Phone:609-954-5166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-23
Last Update Date:2014-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00104500171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist