Provider Demographics
NPI:1568447548
Name:DIAMOND, JILL M (AUD)
Entity Type:Individual
Prefix:DR
First Name:JILL
Middle Name:M
Last Name:DIAMOND
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:21008 NORTHERN BLVD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361-3211
Mailing Address - Country:US
Mailing Address - Phone:718-224-6100
Mailing Address - Fax:718-224-8395
Practice Address - Street 1:21008 NORTHERN BLVD
Practice Address - Street 2:SUITE 5
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11361-3211
Practice Address - Country:US
Practice Address - Phone:718-224-6100
Practice Address - Fax:718-224-8395
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2010-01-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY001917-1231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYMOW041Medicare UPIN