Provider Demographics
NPI:1922170729
Name:HENNESSY, DIANE C (DC CDN)
Entity Type:Individual
Prefix:DR
First Name:DIANE
Middle Name:C
Last Name:HENNESSY
Suffix:
Gender:F
Credentials:DC CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 GRANDVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:NANUET
Mailing Address - State:NY
Mailing Address - Zip Code:10954-2510
Mailing Address - Country:US
Mailing Address - Phone:845-623-3939
Mailing Address - Fax:845-624-5808
Practice Address - Street 1:5 GRANDVIEW AVE
Practice Address - Street 2:
Practice Address - City:NANUET
Practice Address - State:NY
Practice Address - Zip Code:10954-2510
Practice Address - Country:US
Practice Address - Phone:845-623-3939
Practice Address - Fax:845-624-5808
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX005349-1111N00000X
NY004088133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111N00000XChiropractic ProvidersChiropractor
Not Answered133N00000XDietary & Nutritional Service ProvidersNutritionist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5967328OtherAETNA PPO
NYC0-5449-8OtherWORKERS COMPENSATION
NY1014308OtherAMERICAN SPECIALTY HEALTH
NYC0-5449-8OtherWORKERS COMPENSATION