Provider Demographics
NPI:1851631717
Name:OVIEDO, DIOMENES (DIOMENES OVIEDO)
Entity Type:Individual
Prefix:
First Name:DIOMENES
Middle Name:
Last Name:OVIEDO
Suffix:
Gender:M
Credentials:DIOMENES OVIEDO
Other - Prefix:
Other - First Name:DIOMENES
Other - Middle Name:
Other - Last Name:OVIEDO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS ED
Mailing Address - Street 1:102 BRADHURST AVE
Mailing Address - Street 2:UNIT 404
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10039-3305
Mailing Address - Country:US
Mailing Address - Phone:917-399-7714
Mailing Address - Fax:
Practice Address - Street 1:102 BRADHURST AVE
Practice Address - Street 2:UNIT 404
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10039-3305
Practice Address - Country:US
Practice Address - Phone:917-399-7714
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-28
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist