Provider Demographics
NPI:1851411979
Name:KRAMER, DIANE M (DC)
Entity Type:Individual
Prefix:DR
First Name:DIANE
Middle Name:M
Last Name:KRAMER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:261 ROCK RD
Mailing Address - Street 2:
Mailing Address - City:GLEN ROCK
Mailing Address - State:NJ
Mailing Address - Zip Code:07452-1720
Mailing Address - Country:US
Mailing Address - Phone:201-652-6505
Mailing Address - Fax:201-652-3305
Practice Address - Street 1:519 S BROAD ST
Practice Address - Street 2:
Practice Address - City:GLEN ROCK
Practice Address - State:NJ
Practice Address - Zip Code:07452-1309
Practice Address - Country:US
Practice Address - Phone:201-652-6505
Practice Address - Fax:201-652-3305
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2009-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00182900111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ620680X55Medicare PIN