Provider Demographics
NPI:1417968215
Name:DIAZ, FRANCISCO (NP)
Entity Type:Individual
Prefix:
First Name:FRANCISCO
Middle Name:
Last Name:DIAZ
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 FORT WASHINGTON AVENUE
Mailing Address - Street 2:3 B
Mailing Address - City:NY
Mailing Address - State:NY
Mailing Address - Zip Code:10033-6817
Mailing Address - Country:US
Mailing Address - Phone:718-637-3395
Mailing Address - Fax:
Practice Address - Street 1:1111 AMSTERDAM AVE # 1031
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-1716
Practice Address - Country:US
Practice Address - Phone:212-523-8672
Practice Address - Fax:212-523-4206
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY304155363LA2200X
NY304617363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health