Healthcare Provider Details

I. General information

NPI: 1235049115
Provider Name (Legal Business Name): EMILY JADE DIAZ RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 DUMONT AVE
STATEN ISLAND NY
10305-1450
US

IV. Provider business mailing address

401 SIMONSON AVE
STATEN ISLAND NY
10303-2553
US

V. Phone/Fax

Practice location:
  • Phone: 718-667-4282
  • Fax:
Mailing address:
  • Phone: 718-902-9293
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberN55503
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: