Provider Demographics
NPI:1760904783
Name:CHOE, DIANA D (LAC)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:D
Last Name:CHOE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 MOUNT BETHEL RD STE C
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:NJ
Mailing Address - Zip Code:07059-2636
Mailing Address - Country:US
Mailing Address - Phone:908-380-7764
Mailing Address - Fax:
Practice Address - Street 1:7 MOUNT BETHEL RD STE C
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:NJ
Practice Address - Zip Code:07059-2636
Practice Address - Country:US
Practice Address - Phone:908-380-7764
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-11
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00126200171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist