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NPI Code Detail

MEDICARE: MR. KEITH DIAMOND R.PH., C.PED

MEDICARE: MR. KEITH DIAMOND R.PH., C.PED
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist034707NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1CFO00361OTHERCERTIFIED FITTER - ORTHOTICS
2034707OTHERNYSTATE BOARD OF PHARMACY LICENSE
39912OTHERCERTIFIED PEDORTHIST

General Provider Information

NPI Number : 1619117785
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. KEITH DIAMOND R.PH., C.PED
Provider Business Mailing Address
First Line : 2064 FLATBUSH AVE
Second Line :
City : BROOKLYN
State : NY
Zip : 11234-4314
Country : US
Telephone Number : 718-377-4900
Fax Number : 718-253-1568
Provider Business Practice Location Address
First Line : 2064 FLATBUSH AVE
Second Line :
City : BROOKLYN
State : NY
Zip : 11234-4314
Country : US
Telephone Number : 718-377-4900
Fax Number : 718-253-1568
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/02/2009
Last Update Date : 03/02/2009

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