Individual
MRS. DIANE THERESA MIHAILOVICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
29 PINEWOOD DR, COMMACK, NY 11725-5612
(631) 499-1234
Mailing address
29 PINEWOOD DR, COMMACK, NY 11725-5612
(631) 499-1234
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
006656-1
NY
Other
Enumeration date
10/19/2010
Last updated
10/28/2010
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