Provider Demographics
NPI:1548286750
Name:ARDITO, DIANE A (PH D)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:A
Last Name:ARDITO
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 BARKER AVE
Mailing Address - Street 2:4TH FLOOR PARK AVENUE MEDICAL ASSOCIATES PC
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10601-1509
Mailing Address - Country:US
Mailing Address - Phone:914-949-1199
Mailing Address - Fax:914-949-1245
Practice Address - Street 1:3 BARKER AVE
Practice Address - Street 2:4TH FLOOR PARK AVENUE MEDICAL ASSOCIATES PC
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10601-1509
Practice Address - Country:US
Practice Address - Phone:914-949-1199
Practice Address - Fax:914-949-1245
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015983103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02569299Medicaid
0340ESMedicare ID - Type UnspecifiedGHI
NY02569299Medicaid
VM5691Medicare ID - Type Unspecified