Provider Demographics
NPI:1760664395
Name:DIAMOND MEDICAL GROUP, P.C.
Entity Type:Organization
Organization Name:DIAMOND MEDICAL GROUP, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:BARTH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-785-6800
Mailing Address - Street 1:PO BOX 57
Mailing Address - Street 2:
Mailing Address - City:BELLMORE
Mailing Address - State:NY
Mailing Address - Zip Code:11710-0057
Mailing Address - Country:US
Mailing Address - Phone:516-785-6800
Mailing Address - Fax:516-785-2121
Practice Address - Street 1:1488 WANTAGH AVE
Practice Address - Street 2:
Practice Address - City:WANTAGH
Practice Address - State:NY
Practice Address - Zip Code:11793-2204
Practice Address - Country:US
Practice Address - Phone:516-785-6800
Practice Address - Fax:516-785-2121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-05
Last Update Date:2015-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWED571Medicare PIN