Provider Demographics
NPI:1710949250
Name:JANKIEWICZ, DIANE STEPHANIE (PT)
Entity Type:Individual
Prefix:MISS
First Name:DIANE
Middle Name:STEPHANIE
Last Name:JANKIEWICZ
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 UPDIKES MILL RD
Mailing Address - Street 2:
Mailing Address - City:BELLE MEAD
Mailing Address - State:NJ
Mailing Address - Zip Code:08502
Mailing Address - Country:US
Mailing Address - Phone:908-281-5729
Mailing Address - Fax:908-281-5729
Practice Address - Street 1:108 RIDGE ROAD
Practice Address - Street 2:
Practice Address - City:NORTH ARLINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07031
Practice Address - Country:US
Practice Address - Phone:201-997-3234
Practice Address - Fax:201-997-3417
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00373900225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
520347Medicare ID - Type Unspecified