Provider Demographics
NPI:1336610716
Name:SCARLET, DIAN ANN (HAIR LOSS SPT)
Entity type:Individual
Prefix:
First Name:DIAN
Middle Name:ANN
Last Name:SCARLET
Suffix:
Gender:F
Credentials:HAIR LOSS SPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 CONVENT AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10027-2604
Mailing Address - Country:US
Mailing Address - Phone:718-607-4253
Mailing Address - Fax:
Practice Address - Street 1:89-28 MERRICK BLVD
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11433
Practice Address - Country:US
Practice Address - Phone:718-607-4253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-11
Last Update Date:2018-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management