Provider Demographics
NPI:1982791067
Name:DIFEDE, JOANN (PHD)
Entity Type:Individual
Prefix:
First Name:JOANN
Middle Name:
Last Name:DIFEDE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 EAST 68TH STREET
Mailing Address - Street 2:WMC-NYPH BOX 200
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065
Mailing Address - Country:US
Mailing Address - Phone:212-746-3029
Mailing Address - Fax:212-746-7481
Practice Address - Street 1:1320 YORK AVE RM 610
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-4800
Practice Address - Country:US
Practice Address - Phone:212-749-3079
Practice Address - Fax:212-746-3687
Is Sole Proprietor?:No
Enumeration Date:2006-10-09
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0115012084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV93561Medicare PIN