Provider Demographics
NPI:1629391206
Name:DIAMOND MEDICAL PC
Entity Type:Organization
Organization Name:DIAMOND MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:DELYS
Authorized Official - Middle Name:
Authorized Official - Last Name:ST. HILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-241-7910
Mailing Address - Street 1:25 W 132ND ST
Mailing Address - Street 2:5C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10037-3202
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1865 AMSTERDAM AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10031-1716
Practice Address - Country:US
Practice Address - Phone:212-568-7403
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-10
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF31415Medicare UPIN