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NPI Code Detail

MEDICARE: ERIC DIEM PT

MEDICARE: ERIC DIEM PT
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
1225100000XPhysical Therapist016578NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1689750762
Entity Type Code : Individual
Provider Name (Legal Business Name) : ERIC DIEM PT
Provider Business Mailing Address
First Line : 201 CHURCH ST
Second Line :
City : SARATOGA SPRINGS
State : NY
Zip : 12866-1009
Country : US
Telephone Number : 518-580-2022
Fax Number : 518-584-0466
Provider Business Practice Location Address
First Line : 200 BROAD ST
Second Line :
City : SCHUYLERVILLE
State : NY
Zip : 12871-1024
Country : US
Telephone Number : 518-695-3668
Fax Number : 518-695-3614
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/31/2006
Last Update Date : 07/09/2007

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Directions to “ ERIC DIEM PT” Practice Location

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