Provider Demographics
NPI:1407930449
Name:DIAMOND, LESLIE (OTR, CHT)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:DIAMOND
Suffix:
Gender:F
Credentials:OTR, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 UNIVERSITY PL
Mailing Address - Street 2:8TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-4515
Mailing Address - Country:US
Mailing Address - Phone:212-604-1316
Mailing Address - Fax:212-604-1320
Practice Address - Street 1:95 UNIVERSITY PL
Practice Address - Street 2:8TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-4515
Practice Address - Country:US
Practice Address - Phone:212-604-1316
Practice Address - Fax:212-604-1320
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010596-1225XH1200X
CT003559225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQU560QAQX1Medicare PIN
CTD400023187Medicare PIN