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NPI Code Detail

MEDICARE: DIAMOND MADDOX

MEDICARE: DIAMOND MADDOX
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
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1639972052
Entity Type Code : Individual
Provider Name (Legal Business Name) : DIAMOND MADDOX
Provider Business Mailing Address
First Line : 507 BEACH 64TH ST
Second Line :
City : ARVERNE
State : NY
Zip : 11692-1326
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 507 BEACH 64TH ST
Second Line :
City : ARVERNE
State : NY
Zip : 11692-1326
Country : US
Telephone Number : 347-886-7321
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/31/2025
Last Update Date : 03/31/2025

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Directions to “ DIAMOND MADDOX ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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