Healthcare Provider Details

I. General information

NPI: 1437113107
Provider Name (Legal Business Name): FRANCO DIAZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2006
Last Update Date: 09/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

452 OLD HOOK RD
EMERSON NJ
07630-1381
US

IV. Provider business mailing address

452 OLD HOOK RD
EMERSON NJ
07630-1381
US

V. Phone/Fax

Practice location:
  • Phone: 201-666-3900
  • Fax: 201-261-0505
Mailing address:
  • Phone: 201-666-3900
  • Fax: 201-261-0505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA02203500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: