Provider Demographics
NPI:1457529422
Name:DIAMOND, ANDREA HOPE (CNM)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:HOPE
Last Name:DIAMOND
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2183 OCEAN AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-2303
Mailing Address - Country:US
Mailing Address - Phone:718-376-6655
Mailing Address - Fax:718-336-4113
Practice Address - Street 1:2229 KNAPP ST APT 4B
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-5715
Practice Address - Country:US
Practice Address - Phone:303-578-6899
Practice Address - Fax:718-873-9668
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-13
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF001298367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYW86111Medicaid
NY03017925Medicaid