Provider Demographics
NPI:1699218438
Name:MARMO, DIANE (SLP)
Entity type:Individual
Prefix:MS
First Name:DIANE
Middle Name:
Last Name:MARMO
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419 E 66TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-6303
Mailing Address - Country:US
Mailing Address - Phone:212-734-7719
Mailing Address - Fax:212-861-8314
Practice Address - Street 1:419 E 66TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-6303
Practice Address - Country:US
Practice Address - Phone:212-734-7719
Practice Address - Fax:212-861-8314
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-28
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009164-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist