Provider Demographics
NPI:1457785958
Name:DIAMOND, KRISTIN
Entity Type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:
Last Name:DIAMOND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 HENEARLY DR
Mailing Address - Street 2:
Mailing Address - City:MILLER PLACE
Mailing Address - State:NY
Mailing Address - Zip Code:11764-3302
Mailing Address - Country:US
Mailing Address - Phone:631-848-9359
Mailing Address - Fax:
Practice Address - Street 1:28 HENEARLY DR
Practice Address - Street 2:
Practice Address - City:MILLER PLACE
Practice Address - State:NY
Practice Address - Zip Code:11764-3302
Practice Address - Country:US
Practice Address - Phone:631-848-9359
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-03
Last Update Date:2021-07-12
Deactivation Date:2016-05-27
Deactivation Code:
Reactivation Date:2021-07-12
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist