Healthcare Provider Details

I. General information

NPI: 1811253263
Provider Name (Legal Business Name): LEWIS PATRICK DIAMOND MBBCH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2012
Last Update Date: 05/24/2022
Certification Date: 05/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 E 210TH ST DEPT OF
BRONX NY
10467-2401
US

IV. Provider business mailing address

111 E 210TH ST FL 4
BRONX NY
10467-2401
US

V. Phone/Fax

Practice location:
  • Phone: 718-920-4316
  • Fax:
Mailing address:
  • Phone: 718-920-4316
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number042-0015943
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number275137
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License Number275137
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: