Provider Demographics
NPI:1215050679
Name:DIANTO, NICHOLAS L (DC)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:L
Last Name:DIANTO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:817 W FINGERBOARD RD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-1539
Mailing Address - Country:US
Mailing Address - Phone:718-720-0222
Mailing Address - Fax:718-876-0233
Practice Address - Street 1:817 W FINGERBOARD RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-1539
Practice Address - Country:US
Practice Address - Phone:718-720-0222
Practice Address - Fax:718-876-0233
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002366-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor