Provider Demographics
NPI:1588060586
Name:DIAZ, JOSE
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:
Last Name:DIAZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:545 1ST AVE
Mailing Address - Street 2:GREENBERG HALL, SUITE C-124
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-6401
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:545 1ST AVE
Practice Address - Street 2:GREENBERG HALL, SUITE C-124
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-6401
Practice Address - Country:US
Practice Address - Phone:646-501-4266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-18
Last Update Date:2015-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY649797163W00000X
NY430920363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163W00000XNursing Service ProvidersRegistered Nurse