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General NPI Number Information
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NPI Number | 1346592417
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Entity Type | Individual
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Provider Name | JOSE JUAN DIAZ HERNANDEZ M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/12/2012
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Last Update Date | 10/12/2012
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Provider Practice Location Address
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Address Line | 201 LYONS AVE
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City | NEWARK
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State | NJ
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Zip | 07112-2027
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Country | US
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Telephone | 973-926-7000
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Fax |
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Provider Business Mailing Address
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Address Line | 1510 LEXINGTON AVE APT 8B
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City | NEW YORK
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State | NY
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Zip | 10029-7159
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Country | US
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Telephone | 415-407-6782
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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 | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number | 25MA09202800
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number | 260231
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License Number State | NY
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