Provider Demographics
NPI:1255422291
Name:DIAMOND, MICHAEL KALMAN I (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:KALMAN
Last Name:DIAMOND
Suffix:I
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:MICHAEL
Other - Middle Name:KALMAN
Other - Last Name:DIAMOND
Other - Suffix:I
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:86 MILBURN LN
Mailing Address - Street 2:
Mailing Address - City:ROSLYN HTS
Mailing Address - State:NY
Mailing Address - Zip Code:11577-1514
Mailing Address - Country:US
Mailing Address - Phone:516-484-5999
Mailing Address - Fax:516-484-6005
Practice Address - Street 1:115 E 61ST ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-8183
Practice Address - Country:US
Practice Address - Phone:212-486-6096
Practice Address - Fax:212-486-8899
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026361223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02636OtherNY STATE LICENSE