Healthcare Provider Details

I. General information

NPI: 1942819719
Provider Name (Legal Business Name): DIAMOND MEDICAL NJ
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2020
Last Update Date: 07/28/2020
Certification Date: 07/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 JOURNAL SQ STE 915
JERSEY CITY NJ
07306-4007
US

IV. Provider business mailing address

25 W 132ND ST APT 5C
NEW YORK NY
10037-3220
US

V. Phone/Fax

Practice location:
  • Phone: 914-376-6100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DELYS ST HILL
Title or Position: PRESIDENT
Credential: MD
Phone: 914-376-6100