Provider Demographics
NPI:1083604912
Name:DIAMOND, ALAN EDWARD (ATC)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:EDWARD
Last Name:DIAMOND
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 KUSER RD
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08691-3386
Mailing Address - Country:US
Mailing Address - Phone:609-587-4777
Mailing Address - Fax:609-587-4349
Practice Address - Street 1:2501 KUSER RD
Practice Address - Street 2:3RD FLOOR
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08691-3386
Practice Address - Country:US
Practice Address - Phone:609-587-4777
Practice Address - Fax:609-587-4349
Is Sole Proprietor?:No
Enumeration Date:2005-10-22
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT3715225200000X
CA2255A2300X
PART0056382255A2300X
NJ25MT000430002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant