Provider Demographics
NPI:1952664765
Name:PLANZ, DANA MARIE (MSED)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:MARIE
Last Name:PLANZ
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:DANA
Other - Middle Name:MARIE
Other - Last Name:PINTO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSED
Mailing Address - Street 1:15 SHEARWATER WAY
Mailing Address - Street 2:
Mailing Address - City:CENTEREACH
Mailing Address - State:NY
Mailing Address - Zip Code:11720-4313
Mailing Address - Country:US
Mailing Address - Phone:631-820-1984
Mailing Address - Fax:
Practice Address - Street 1:15 SHEARWATER WAY
Practice Address - Street 2:
Practice Address - City:CENTEREACH
Practice Address - State:NY
Practice Address - Zip Code:11720-4313
Practice Address - Country:US
Practice Address - Phone:631-820-1984
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-18
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1836012174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY174400000XOtherTEACHER