Provider Demographics
NPI:1891858791
Name:DIAMOND, HOWARD (DPM)
Entity Type:Individual
Prefix:
First Name:HOWARD
Middle Name:
Last Name:DIAMOND
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5210 108 STREET
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:NY
Mailing Address - Zip Code:11368
Mailing Address - Country:US
Mailing Address - Phone:718-271-9016
Mailing Address - Fax:718-595-1806
Practice Address - Street 1:5210 108 STREET
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:NY
Practice Address - Zip Code:11368
Practice Address - Country:US
Practice Address - Phone:718-271-9016
Practice Address - Fax:718-595-1865
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN0036291213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00845354Medicaid
NYPJ3101Medicare PIN
NY60336Medicare PIN
NY4187520001Medicare NSC
NY00845354Medicaid