Provider Demographics
NPI:1902154016
Name:FORD, DIANA (MSED)
Entity Type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:
Last Name:FORD
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:MS
Other - First Name:DIANA
Other - Middle Name:
Other - Last Name:LODICO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12 HARVEST LN
Mailing Address - Street 2:
Mailing Address - City:LEVITTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11756-2724
Mailing Address - Country:US
Mailing Address - Phone:516-934-0001
Mailing Address - Fax:
Practice Address - Street 1:12 HARVEST LN
Practice Address - Street 2:
Practice Address - City:LEVITTOWN
Practice Address - State:NY
Practice Address - Zip Code:11756-2724
Practice Address - Country:US
Practice Address - Phone:516-934-0001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-21
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist