Provider Demographics
NPI:1215339239
Name:MESS, DIANE F (LAC)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:F
Last Name:MESS
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1004
Mailing Address - Street 2:
Mailing Address - City:FORKED RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08731
Mailing Address - Country:US
Mailing Address - Phone:732-688-2058
Mailing Address - Fax:609-488-5756
Practice Address - Street 1:535 LACEY RD STE 1
Practice Address - Street 2:
Practice Address - City:FORKED RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08731-1533
Practice Address - Country:US
Practice Address - Phone:732-688-2058
Practice Address - Fax:609-488-5756
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-22
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00106300171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist