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General NPI Number Information
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NPI Number | 1487672945
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Entity Type | Individual
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Provider Name | JILL R DIETZ MD
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Gender | Female
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Dates
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Enumeration Date | 07/17/2006
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Last Update Date | 10/10/2024
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Provider Practice Location Address
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Address Line | 1111 FRANKLIN AVE
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City | GARDEN CITY
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State | NY
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Zip | 11530-1617
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Country | US
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Telephone | 516-663-1950
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Fax | 516-741-3562
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Provider Business Mailing Address
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Address Line | 1111 FRANKLIN AVE
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City | GARDEN CITY
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State | NY
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Zip | 11530-1617
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Country | US
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Telephone | 516-663-1950
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Fax | 516-741-3562
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | MD474935
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 333332
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License Number State | NY
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