Provider Demographics
NPI:1144627696
Name:DIFFENDERFER, MARY
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:DIFFENDERFER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6458 DEHIRSH AVE
Mailing Address - Street 2:
Mailing Address - City:MAYS LANDING
Mailing Address - State:NJ
Mailing Address - Zip Code:08330-3527
Mailing Address - Country:US
Mailing Address - Phone:609-431-2460
Mailing Address - Fax:
Practice Address - Street 1:6458 DEHIRSH AVE
Practice Address - Street 2:
Practice Address - City:MAYS LANDING
Practice Address - State:NJ
Practice Address - Zip Code:08330-3527
Practice Address - Country:US
Practice Address - Phone:609-431-2460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-28
Last Update Date:2014-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant