Basic Information
Provider Information
NPI: 1184744062
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DIAMOND
FirstName: BETTY
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 972 BRUSH HOLLOW RD
Address2:  
City: WESTBURY
State: NY
PostalCode: 115901740
CountryCode: US
TelephoneNumber: 5168765555
FaxNumber: 5168761246
Practice Location
Address1: 330 COMMUNITY DR
Address2:  
City: MANHASSET
State: NY
PostalCode: 110303816
CountryCode: US
TelephoneNumber: 5165621001
FaxNumber:  
Other Information
ProviderEnumerationDate: 04/02/2007
LastUpdateDate: 07/21/2008
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RR0500X122782NYY Allopathic & Osteopathic PhysiciansInternal MedicineRheumatology

No ID Information.


Home