Provider Demographics
NPI:1306074240
Name:DIDNER, PATRICIA A (LAC)
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:A
Last Name:DIDNER
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3450 41ST ST
Mailing Address - Street 2:APT. C-15
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11101-1339
Mailing Address - Country:US
Mailing Address - Phone:347-233-0513
Mailing Address - Fax:
Practice Address - Street 1:214 W 29TH ST
Practice Address - Street 2:SUITE 901
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-5203
Practice Address - Country:US
Practice Address - Phone:347-233-0513
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-30
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003843171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist