Provider Demographics
NPI:1831118389
Name:DIAMOND, ERIC ALLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:ALLEN
Last Name:DIAMOND
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1171 OLD COUNTRY RD
Mailing Address - Street 2:SUITE # 5
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-5022
Mailing Address - Country:US
Mailing Address - Phone:516-933-3323
Mailing Address - Fax:516-938-7718
Practice Address - Street 1:1171 OLD COUNTRY RD
Practice Address - Street 2:SUITE # 5
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-5022
Practice Address - Country:US
Practice Address - Phone:516-933-3323
Practice Address - Fax:516-938-7718
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2010-10-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY141261208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00797360Medicaid
NYC04971Medicare UPIN
05D321Medicare PIN