Provider Demographics
NPI:1942270467
Name:DIAZ, DIEGO A (MD)
Entity Type:Individual
Prefix:DR
First Name:DIEGO
Middle Name:A
Last Name:DIAZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:110 E 59TH ST
Mailing Address - Street 2:SUITE 9C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-1304
Mailing Address - Country:US
Mailing Address - Phone:212-583-2850
Mailing Address - Fax:212-644-8666
Practice Address - Street 1:110 E 59TH ST
Practice Address - Street 2:SUITE 9C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-1304
Practice Address - Country:US
Practice Address - Phone:212-583-2850
Practice Address - Fax:212-644-8666
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-26
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY211166207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01884284Medicaid
NY211166OtherLICENSE
BD5042813OtherDEA#
NYG81791Medicare UPIN
BD5042813OtherDEA#