Healthcare Provider Details

I. General information

NPI: 1356694889
Provider Name (Legal Business Name): ESTHER HADASSAH DIAMOND CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2012
Last Update Date: 10/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1805 ATTAYA RD
LAKEWOOD NJ
08701-2902
US

IV. Provider business mailing address

1805 ATTAYA RD
LAKEWOOD NJ
08701-2902
US

V. Phone/Fax

Practice location:
  • Phone: 732-370-2485
  • Fax:
Mailing address:
  • Phone: 732-370-2485
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number25ME00050201
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: