Provider Demographics
NPI:1144525528
Name:DIAMOND, GERETHA M (RN, NP)
Entity type:Individual
Prefix:
First Name:GERETHA
Middle Name:M
Last Name:DIAMOND
Suffix:
Gender:F
Credentials:RN, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 INDEPENDENCE DR
Mailing Address - Street 2:
Mailing Address - City:MANHASSET HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11040-1023
Mailing Address - Country:US
Mailing Address - Phone:917-359-1096
Mailing Address - Fax:516-869-0560
Practice Address - Street 1:8 INDEPENDENCE DR
Practice Address - Street 2:
Practice Address - City:MANHASSET HILLS
Practice Address - State:NY
Practice Address - Zip Code:11040-1023
Practice Address - Country:US
Practice Address - Phone:917-359-1096
Practice Address - Fax:516-869-0560
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-17
Last Update Date:2014-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF401354-1363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG400150587Medicare PIN
NYA400072943Medicare PIN