Healthcare Provider Details

I. General information

NPI: 1255422291
Provider Name (Legal Business Name): MICHAEL KALMAN DIAMOND I DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: MICHAEL KALMAN DIAMOND I DDS

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 E 61ST ST
NEW YORK NY
10021-8183
US

IV. Provider business mailing address

86 MILBURN LN
ROSLYN HTS NY
11577-1514
US

V. Phone/Fax

Practice location:
  • Phone: 212-486-6096
  • Fax: 212-486-8899
Mailing address:
  • Phone: 516-484-5999
  • Fax: 516-484-6005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number02636
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: