Provider Demographics
NPI:1437112356
Name:DIAMOND, EZRIEL (MD)
Entity Type:Individual
Prefix:
First Name:EZRIEL
Middle Name:
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 1:688 OLD COUNTRY RD
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-4911
Mailing Address - Country:US
Mailing Address - Phone:516-932-6007
Mailing Address - Fax:516-932-6017
Practice Address - Street 1:688 OLD COUNTRY RD
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-4911
Practice Address - Country:US
Practice Address - Phone:516-932-6007
Practice Address - Fax:516-932-6017
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2011-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1437572085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
C12155Medicare UPIN