Provider Demographics
NPI:1518920461
Name:DIAMOND, PAUL MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:MICHAEL
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 1:205 N WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:BERGENFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07621-1359
Mailing Address - Country:US
Mailing Address - Phone:201-384-9255
Mailing Address - Fax:201-384-2758
Practice Address - Street 1:205 N WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:BERGENFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07621-1359
Practice Address - Country:US
Practice Address - Phone:201-384-9255
Practice Address - Fax:201-384-2758
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03758200207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJC55136Medicare UPIN