Diane Dettmore

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

26NJ00456900 Issued in NJ

Practice address

1340 Hamburg Tpke
Wayne, NJ 07470-4003

Phone

(973) 633-1996

NPI assigned

May 18, 2014

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Kashoqa Psychiatry Associates PC

  • Psychiatry Physician
  • Wayne, NJ
  • NPI 1568539203
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1400371200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1400371200000",
    "number": "1285045757",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "57 MONTROSS AVE",
            "city": "RUTHERFORD",
            "state": "NJ",
            "postal_code": "070701147",
            "telephone_number": "551-206-9812"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1340 HAMBURG TPKE",
            "city": "WAYNE",
            "state": "NJ",
            "postal_code": "074704003",
            "telephone_number": "973-633-1996"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DETTMORE",
        "first_name": "DIANE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-05-18",
        "last_updated": "2014-05-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NJ",
            "license": "26NJ00456900",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elizabeth Derka, PHARMD
• Jamie Deruyter Swart, LPC
• Meghna Desai
• Nawal M Desoky, M.D.
• Rachael Theresa Detore
• Jeffrey Edwin Devack, D.D.S.
• Malvi Devanathan
• Aynur A. Devli, MD
• Gregory Devries, D.M.D.
• Rohit Dhar

• Psychiatric/Mental Health Nurse Practitioner in Wayne, NJ
• Providers in Wayne, NJ by specialty
• Psychiatric/Mental Health Nurse Practitioner in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.