Healthcare Provider Details

I. General information

NPI: 1437112356
Provider Name (Legal Business Name): EZRIEL DIAMOND MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 04/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

688 OLD COUNTRY RD
PLAINVIEW NY
11803-4911
US

IV. Provider business mailing address

688 OLD COUNTRY RD
PLAINVIEW NY
11803-4911
US

V. Phone/Fax

Practice location:
  • Phone: 516-932-6007
  • Fax: 516-932-6017
Mailing address:
  • Phone: 516-932-6007
  • Fax: 516-932-6017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number143757
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: