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NPI Code Detail

MEDICARE: JAMES THOMAS DIEDRICH

MEDICARE:   JAMES THOMAS DIEDRICH
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 ProgramNY

General Provider Information

NPI Number : 1740137728
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAMES THOMAS DIEDRICH
Provider Business Mailing Address
First Line : 2 TUBBERMORE ROAD
Second Line :
City : DALKEY
State : CO DUBLIN
Zip : A96A8R2
Country : IE
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1275 YORK AVE
Second Line :
City : NEW YORK
State : NY
Zip : 10065-6007
Country : US
Telephone Number : 347-798-9213
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/11/2026
Last Update Date : 03/11/2026

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Directions to “ JAMES THOMAS DIEDRICH ” Practice Location

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