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NPI Code Detail

MEDICARE: JILL LAUREN DIEMER PA

MEDICARE: JILL LAUREN DIEMER PA
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
1363A00000XPhysician Assistant011381NY

General Provider Information

NPI Number : 1700973666
Entity Type Code : Individual
Provider Name (Legal Business Name) : JILL LAUREN DIEMER PA
Provider Business Mailing Address
First Line : 1231 DEER PARK AVE
Second Line :
City : NORTH BABYLON
State : NY
Zip : 11703-3104
Country : US
Telephone Number : 631-667-0388
Fax Number : 631-968-7705
Provider Business Practice Location Address
First Line : 1231 DEER PARK AVE
Second Line :
City : NORTH BABYLON
State : NY
Zip : 11703-3104
Country : US
Telephone Number : 631-667-0388
Fax Number : 631-968-7705
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/10/2006
Last Update Date : 01/03/2025

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Directions to “ JILL LAUREN DIEMER PA” Practice Location

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