Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 029383-1 | NY |
NPI | 1134410822 |
---|---|
Provider Name | Dr. Richard Diamond |
First Address | New York, NY 10032-3725 |
Second Address | New York, NY 10032-3725 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/04/2011 |
Last Update Date | 28/04/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D40116667712422 | DRIVERS LICENSE NJ (01) | NJ |