Provider Demographics
NPI:1972948073
Name:DIAZ, MICHAEL J (RN)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:J
Last Name:DIAZ
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:226 E 144TH ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10451-5909
Mailing Address - Country:US
Mailing Address - Phone:855-681-8700
Mailing Address - Fax:
Practice Address - Street 1:226 E 144TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451-5909
Practice Address - Country:US
Practice Address - Phone:855-681-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-02
Last Update Date:2015-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY692583163WP2201X
NY311664164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care