Provider Demographics
NPI:1720143472
Name:DIAKOS, GEORGIA M (RN,PMHCNS-BC, APN, C)
Entity Type:Individual
Prefix:MS
First Name:GEORGIA
Middle Name:M
Last Name:DIAKOS
Suffix:
Gender:F
Credentials:RN,PMHCNS-BC, APN, C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:186 PATERSON AVE
Mailing Address - Street 2:SUITE 304
Mailing Address - City:EAST RUTHERFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07073-1837
Mailing Address - Country:US
Mailing Address - Phone:201-394-6219
Mailing Address - Fax:
Practice Address - Street 1:186 PATERSON AVE
Practice Address - Street 2:SUITE 304
Practice Address - City:EAST RUTHERFORD
Practice Address - State:NJ
Practice Address - Zip Code:07073-1837
Practice Address - Country:US
Practice Address - Phone:201-394-6219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-23
Last Update Date:2014-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00082900364SP0809X
NY7883494163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult