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General NPI Number Information
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NPI Number | 1710105804
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Entity Type | Individual
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Provider Name | DIANE GAIDON PT,MS,OCS,CFMT
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Gender | Female
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Dates
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Enumeration Date | 04/23/2007
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Last Update Date | 10/14/2014
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Provider Practice Location Address
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Address Line | 23 WHITNEY DR
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City | AMITYVILLE
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State | NY
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Zip | 11701-3324
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Country | US
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Telephone | 516-445-8841
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Fax | 631-592-9894
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Provider Business Mailing Address
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Address Line | 23 WHITNEY DR
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City | AMITYVILLE
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State | NY
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Zip | 11701-3324
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Country | US
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Telephone | 516-445-8841
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Fax | 631-592-9894
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 022801
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License Number State | NY
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