Healthcare Provider Details

I. General information

NPI: 1154811735
Provider Name (Legal Business Name): DIANA KATHLEEN MARCHESINI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2018
Last Update Date: 05/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

685 RIVER AVE
LAKEWOOD NJ
08701-5288
US

IV. Provider business mailing address

685 RIVER AVE
LAKEWOOD NJ
08701-5288
US

V. Phone/Fax

Practice location:
  • Phone: 732-367-3667
  • Fax:
Mailing address:
  • Phone: 732-367-3667
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: