Provider Demographics
NPI:1730301821
Name:DR. MICHAEL J. DIAMOND, PA
Entity Type:Organization
Organization Name:DR. MICHAEL J. DIAMOND, PA
Other - Org Name:ORANGE STREET DENTAL
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:DIAMOND
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:973-481-5000
Mailing Address - Street 1:509 ORANGE ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07107-2128
Mailing Address - Country:US
Mailing Address - Phone:973-481-5000
Mailing Address - Fax:973-481-0353
Practice Address - Street 1:509 ORANGE ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07107-2128
Practice Address - Country:US
Practice Address - Phone:973-481-5000
Practice Address - Fax:973-481-0353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI009134001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty