Provider Demographics
NPI:1609857853
Name:DIAZ, MARK ANTHONY (PT)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:ANTHONY
Last Name:DIAZ
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:820 HEMPSTEAD TPKE
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN SQUARE
Mailing Address - State:NY
Mailing Address - Zip Code:11010-4342
Mailing Address - Country:US
Mailing Address - Phone:516-358-8911
Mailing Address - Fax:516-358-8960
Practice Address - Street 1:820 HEMPSTEAD TPKE
Practice Address - Street 2:
Practice Address - City:FRANKLIN SQUARE
Practice Address - State:NY
Practice Address - Zip Code:11010-4342
Practice Address - Country:US
Practice Address - Phone:516-358-8911
Practice Address - Fax:516-358-8960
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021050-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY650024429OtherRAILROAD MEDICARE
NY2134141OtherVYTRA # EAST MEADOW
NY412155POtherHIP PRIS# FR.SQ
NY6697222OtherGHI # EAST MEADOW
NYQC5721OtherEMPIRE BCBS
NY6401276OtherUHC GOVERNMENT PLAN
NY124290POtherHIP # LEVITTOWN
NY2066214OtherUNITED HEALTH CARE
NYQ13C21OtherEMPIRE BCBS # LEVITTOWN
NY191315POtherHIP # EAST MEADOW
NY354958200OtherDEPARTMENT OF LABOR
NYP3560062OtherOXFORD # EAST MEADOW
NY2066214OtherUHC # EAST MEADOW
NY6698676OtherGHI
NY825664OtherMPN # LEVITTOWN
NYQ18V11OtherEMPIRE BCBS
NY1165953OtherMULTIPLAN
NY127979OtherVYTRA
NY650024429OtherRAILROAD MEDICARE
NYQ13C21OtherEMPIRE BCBS # LEVITTOWN