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General NPI Number Information
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NPI Number | 1639621204
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Entity Type | Organization
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Legal Business Name | DIANE L. ESPER
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Dates
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Enumeration Date | 10/31/2016
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Last Update Date | 10/31/2016
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Provider Practice Location Address
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Address Line | 412 6TH AVE SUITE 406
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City | NEW YORK
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State | NY
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Zip | 10011-8409
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Country | US
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Telephone | 917-841-2459
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Fax |
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Provider Business Mailing Address
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Address Line | 15 FORT CHARLES PL
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City | BRONX
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State | NY
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Zip | 10463-6704
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Country | US
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Telephone | 917-841-2459
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Fax |
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Authorized Official
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Title or Position | LICENSED PSYCHOANALYST
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Name | MS. DIANE LYNNE ESPER
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Credential | LP
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Telephone | 917-841-2459
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 000721
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License Number State | NY
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