Provider Demographics
NPI:1699700450
Name:TAVARES, DIANE (PT)
Entity type:Individual
Prefix:MS
First Name:DIANE
Middle Name:
Last Name:TAVARES
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:DIANE
Other - Middle Name:
Other - Last Name:DEVESCOVI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:3 GREENHILL RD
Mailing Address - Street 2:
Mailing Address - City:PARSIPPANY
Mailing Address - State:NJ
Mailing Address - Zip Code:07054-4703
Mailing Address - Country:US
Mailing Address - Phone:973-386-9000
Mailing Address - Fax:973-386-1812
Practice Address - Street 1:3 GREENHILL RD
Practice Address - Street 2:
Practice Address - City:PARSIPPANY
Practice Address - State:NJ
Practice Address - Zip Code:07054-4703
Practice Address - Country:US
Practice Address - Phone:973-386-9000
Practice Address - Fax:973-386-1812
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00767300225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP3592053OtherOXFORD FREEDOM PLAN
NJP3424157OtherAETNA OPEN ACCESS
NJ2K6509OtherHEALTH NET
NJ7104649OtherCIGNA
NJ2308875OtherUNITED HEALTHCARE
NJ3170904OtherAETNA HMO
NJP3592053OtherOXFORD FREEDOM PLAN