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General NPI Number Information
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NPI Number | 1841434560
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Entity Type | Organization
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Legal Business Name | DOCTORDIEGO PHYSICIAN PC
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Dates
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Enumeration Date | 04/24/2009
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Last Update Date | 09/14/2009
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Provider Practice Location Address
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Address Line | 8801 PARSONS BLVD
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City | JAMAICA
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State | NY
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Zip | 11432-3841
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Country | US
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Telephone | 718-526-3400
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Fax | 718-526-7438
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Provider Business Mailing Address
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Address Line | 8801 PARSONS BLVD
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City | JAMAICA
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State | NY
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Zip | 11432-3841
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Country | US
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Telephone | 718-526-3400
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DIEGO A PONIEMAN
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Credential | MD
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Telephone | 718-526-3400
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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 | 236424
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License Number State | NY
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