MEDICARE: DIPLOMATE MEDICAL CARE, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	495578	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	495578	OTHER	NY	THE JOINT COMMISSION

General Provider Information

NPI Number	:	1285952812
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIPLOMATE MEDICAL CARE, PLLC

Provider Business Mailing Address
First Line	:	14 WASHINGTON AVE
Second Line	:	SUITE 2
City	:	BRENTWOOD
State	:	NY
Zip	:	11717-3247
Country	:	US
Telephone Number	:	631-575-6430
Fax Number	:	631-617-5576

Provider Business Practice Location Address
First Line	:	14 WASHINGTON AVE
Second Line	:	SUITE 2
City	:	BRENTWOOD
State	:	NY
Zip	:	11717-3247
Country	:	US
Telephone Number	:	631-575-6430
Fax Number	:	631-617-5576

Authorized Official
Title or Position	:	OWNER
Name	:	MR. MEHDI ZAFARNIA
Credential	:
Telephone Number	:	631-575-6430

Provider Enumeration Date	:	05/06/2010
Last Update Date	:	05/08/2010

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