Provider Demographics
NPI:1346222841
Name:DIAMOND, LAWRENCE NEIL (MD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:NEIL
Last Name:DIAMOND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14015 HOLLY AVE
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-3433
Mailing Address - Country:US
Mailing Address - Phone:718-886-0400
Mailing Address - Fax:516-791-2502
Practice Address - Street 1:14015 HOLLY AVE
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-3433
Practice Address - Country:US
Practice Address - Phone:718-886-0400
Practice Address - Fax:516-791-2502
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY155486207Q00000X, 207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Not Answered207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00963924Medicaid
NY48258Medicare ID - Type UnspecifiedGHI
NY38D52Medicare ID - Type UnspecifiedEMPIRE BC/BS OF NY
NY00963924Medicaid