Healthcare Provider Details

I. General information

NPI: 1508519323
Provider Name (Legal Business Name): DIANE TALAL LWAYSI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2022
Last Update Date: 02/01/2022
Certification Date: 01/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

424 CENTRAL AVENEUE
WESTFIELD NJ
07090
US

IV. Provider business mailing address

24 RUSKIN CT
WAYNE NJ
07470-2631
US

V. Phone/Fax

Practice location:
  • Phone: 908-588-7500
  • Fax:
Mailing address:
  • Phone: 973-908-5764
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: