Provider Demographics
NPI:1811069172
Name:DIAMOND, LEE MARTIN (DC)
Entity type:Individual
Prefix:DR
First Name:LEE
Middle Name:MARTIN
Last Name:DIAMOND
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 BARKER AVE
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10601-1608
Mailing Address - Country:US
Mailing Address - Phone:914-949-5666
Mailing Address - Fax:914-949-3130
Practice Address - Street 1:41 BARKER AVE
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10601-1608
Practice Address - Country:US
Practice Address - Phone:914-949-5666
Practice Address - Fax:914-949-3130
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX002408-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX15911Medicare ID - Type UnspecifiedMEDICARE #