Provider Demographics
NPI:1285882936
Name:DIAMANTSTEIN, RAOUL (RPH)
Entity type:Individual
Prefix:MR
First Name:RAOUL
Middle Name:
Last Name:DIAMANTSTEIN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1430 43RD ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219-1657
Mailing Address - Country:US
Mailing Address - Phone:718-435-4124
Mailing Address - Fax:
Practice Address - Street 1:5006 16TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204-1404
Practice Address - Country:US
Practice Address - Phone:718-633-5770
Practice Address - Fax:718-633-5772
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-07
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY30136183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist