Healthcare Provider Details

I. General information

NPI: 1922253061
Provider Name (Legal Business Name): RHONDA CARLA DIENER MA CCC/SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2008
Last Update Date: 11/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8225 164TH ST
JAMAICA NY
11432-1120
US

IV. Provider business mailing address

8115 164TH ST
JAMAICA NY
11432-1118
US

V. Phone/Fax

Practice location:
  • Phone: 718-374-0002
  • Fax: 718-380-3214
Mailing address:
  • Phone: 718-380-3000
  • Fax: 718-380-3214

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number000298
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: