Provider Demographics
NPI:1003028457
Name:DIAZ, OSCAR O (LAC)
Entity Type:Individual
Prefix:MR
First Name:OSCAR
Middle Name:O
Last Name:DIAZ
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5914 58TH DR
Mailing Address - Street 2:#2
Mailing Address - City:MASPETH
Mailing Address - State:NY
Mailing Address - Zip Code:11378-3210
Mailing Address - Country:US
Mailing Address - Phone:718-326-2936
Mailing Address - Fax:718-803-0030
Practice Address - Street 1:3731 69TH ST
Practice Address - Street 2:#1
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-2854
Practice Address - Country:US
Practice Address - Phone:718-803-2007
Practice Address - Fax:718-803-0030
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002694171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1062377Medicare UPIN