Provider Demographics
NPI:1497743967
Name:DIAMOND, JERRY ALBERT II (DMD)
Entity Type:Individual
Prefix:DR
First Name:JERRY
Middle Name:ALBERT
Last Name:DIAMOND
Suffix:II
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 E 28TH ST
Mailing Address - Street 2:APT 2F
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-8507
Mailing Address - Country:US
Mailing Address - Phone:212-725-2908
Mailing Address - Fax:
Practice Address - Street 1:14 PENN PLAZA
Practice Address - Street 2:SUITE 400
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10119
Practice Address - Country:US
Practice Address - Phone:212-563-0095
Practice Address - Fax:212-563-0076
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033550122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist