Provider Demographics
NPI:1467441998
Name:DIAZ, JOAQUIN JR (DPM)
Entity Type:Individual
Prefix:DR
First Name:JOAQUIN
Middle Name:
Last Name:DIAZ
Suffix:JR
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:87-08 JUSTICE AVE
Mailing Address - Street 2:SUITE CK
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373
Mailing Address - Country:US
Mailing Address - Phone:718-899-0900
Mailing Address - Fax:718-899-8118
Practice Address - Street 1:87-08 JUSTICE AVE
Practice Address - Street 2:SUITE CK
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373
Practice Address - Country:US
Practice Address - Phone:718-899-0900
Practice Address - Fax:718-899-8118
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-18
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0046421213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01668762Medicaid
NY0020590OtherGHI
NYP50801OtherBCBS
NY1198200001Medicare NSC
NYP50801OtherBCBS
NY01668762Medicaid
NY0020590OtherGHI