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General NPI Number Information
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NPI Number | 1972948073
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Entity Type | Individual
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Provider Name | MICHAEL J DIAZ APRN
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Gender | Male
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Dates
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Enumeration Date | 05/02/2013
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Last Update Date | 08/04/2025
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Provider Practice Location Address
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Address Line | 1250 SHAKESPEARE AVE
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City | BRONX
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State | NY
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Zip | 10452-3012
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Country | US
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Telephone | 718-583-7736
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Fax | 347-905-4570
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Provider Business Mailing Address
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Address Line | 1250 SHAKESPEARE AVE
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City | BRONX
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State | NY
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Zip | 10452-3012
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Country | US
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Telephone |
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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 | 163WP2201X
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Taxonomy Name | Ambulatory Care Registered Nurse
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License Number | 692583
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 406161
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License Number State | NY
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