Provider Demographics
NPI:1972189363
Name:DIVAN, MARGARET (LMT)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:
Last Name:DIVAN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:MARGARET
Other - Middle Name:
Other - Last Name:DIVAN-WARGO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMT
Mailing Address - Street 1:230 W 107TH ST APT 5F
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-3048
Mailing Address - Country:US
Mailing Address - Phone:347-835-2694
Mailing Address - Fax:
Practice Address - Street 1:230 W 107TH ST APT 5F
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-3048
Practice Address - Country:US
Practice Address - Phone:347-835-2694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-24
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010607-1225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist