Provider Demographics
NPI:1972874873
Name:DIAMOND, MARTIN (DO)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:
Last Name:DIAMOND
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:248 HARBOR LN
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11762-4011
Mailing Address - Country:US
Mailing Address - Phone:516-572-8836
Mailing Address - Fax:
Practice Address - Street 1:248 HARBOR LN
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA PK
Practice Address - State:NY
Practice Address - Zip Code:11762-4011
Practice Address - Country:US
Practice Address - Phone:516-572-8836
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-24
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY89462207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine