Basic Information
| Provider Information | |||||||||
| NPI: | 1700117850 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LAPIDUS | ||||||||
| FirstName: | DIANE | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 456 | ||||||||
| Address2: | |||||||||
| City: | SPRING GLEN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 124830456 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8456475113 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7 MANSION ST | ||||||||
| Address2: | |||||||||
| City: | POUGHKEEPSIE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 126012309 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8454714243 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/28/2010 | ||||||||
| LastUpdateDate: | 01/28/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WC0400X | 335398 | NY | Y | Nursing Service Providers | Registered Nurse | Case Management |
ID Information
| ID | Type | State | Issuer | Description | 335398 | 01 | NY | NYS RN LICENSE | OTHER |