=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558273896
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MICHAEL DIAZ NP IN PSYCHIATRY PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/21/2026
-----------------------------------------------------
Last Update Date | 09/21/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 822 RIDGE RD
-----------------------------------------------------
City | RENSSELAER
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12144-5110
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-924-5195
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 822 RIDGE RD
-----------------------------------------------------
City | RENSSELAER
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12144-5110
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MICHAEL J DIAZ
-----------------------------------------------------
Credential | PMHNP-BC
-----------------------------------------------------
Telephone | 718-924-5195
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------