Provider Demographics
NPI:1285952812
Name:DIPLOMATE MEDICAL CARE, PLLC
Entity type:Organization
Organization Name:DIPLOMATE MEDICAL CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MEHDI
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAFARNIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-575-6430
Mailing Address - Street 1:14 WASHINGTON AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BRENTWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11717-3247
Mailing Address - Country:US
Mailing Address - Phone:631-575-6430
Mailing Address - Fax:631-617-5576
Practice Address - Street 1:14 WASHINGTON AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:BRENTWOOD
Practice Address - State:NY
Practice Address - Zip Code:11717-3247
Practice Address - Country:US
Practice Address - Phone:631-575-6430
Practice Address - Fax:631-617-5576
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-06
Last Update Date:2010-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY495578174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY495578OtherTHE JOINT COMMISSION