Healthcare Provider Details

I. General information

NPI: 1629068457
Provider Name (Legal Business Name): WILLIAM L DIEHL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2005
Last Update Date: 04/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 E NORTHFIELD RD
LIVINGSTON NJ
07039-4532
US

IV. Provider business mailing address

261 JAMES ST SUITE 2G
MORRISTOWN NJ
07960-6392
US

V. Phone/Fax

Practice location:
  • Phone: 973-436-1530
  • Fax: 973-422-0414
Mailing address:
  • Phone: 973-267-6400
  • Fax: 973-267-7295

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number25MA04355800
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number25MA04355800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: