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General NPI Number Information
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NPI Number | 1972520609
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Entity Type | Organization
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Legal Business Name | ELLIOT DIAMOND
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Dates
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Enumeration Date | 07/17/2006
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Last Update Date | 01/26/2012
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Provider Practice Location Address
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Address Line | 123 CHESTNUT ST STE 201
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City | PHILADELPHIA
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State | PA
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Zip | 19106-3051
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Country | US
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Telephone | 215-923-2455
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Fax | 215-923-4535
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Provider Business Mailing Address
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Address Line | 123 CHESTNUT ST. STE 201
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City | PHILADELPHIA
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State | PA
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Zip | 19106-3051
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Country | US
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Telephone | 215-923-2455
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Fax | 215-923-4535
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Authorized Official
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Title or Position | OWNER
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Name | DR. ELLIOT DIAMOND
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Credential | D.P.M.
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Telephone | 215-923-2455
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0000X
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Taxonomy Name | Sports Medicine Podiatrist
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License Number | SC002164L
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License Number State | PA
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