Healthcare Provider Details

I. General information

NPI: 1952364952
Provider Name (Legal Business Name): GEORGE ALFRED DIAZ M.D., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 03/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ONE GUSTAVE LEVY L. PLACE #1497
NEW YORK NY
10029-6500
US

IV. Provider business mailing address

ONE GUSTAVE LEVY L. PLACE#1497
NEW NY
10029-6500
US

V. Phone/Fax

Practice location:
  • Phone: 212-241-6947
  • Fax: 212-860-3316
Mailing address:
  • Phone: 212-241-6947
  • Fax: 212-860-3316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number200748
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207SG0201X
TaxonomyClinical Genetics (M.D.) Physician
License Number200748
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: