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General NPI Number Information
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NPI Number | 1073771556
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Entity Type | Individual
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Provider Name | KEITH THOMAS DIAZ M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/30/2008
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Last Update Date | 09/08/2014
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Provider Practice Location Address
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Address Line | 682 FOREST AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10310-2507
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Country | US
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Telephone | 347-575-9865
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Fax |
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Provider Business Mailing Address
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Address Line | 474 BEDFORD AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10306-5424
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Country | US
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Telephone | 347-575-9865
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 245968
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | 245968
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | 245968
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License Number State | NY
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