# DIPLOMAT MEDICAL GROUP PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1497469894
- **Authorized official:** NARGIZA SOBIROVA (CREDENTIALING SPECIALIST)
- **Authorized official phone:** (718) 934-6714

## Contact information

- **Practice address:** 11515 QUEENS BLVD STE 1, FOREST HILLS, NY 11375
- **Practice address phone:** (718) 807-1634
- **Mailing address:** 11515 QUEENS BLVD STE 1, FOREST HILLS, NY 11375
- **Mailing address phone:** (718) 807-1634

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207PE0004X | Emergency Medical Services (Emergency Medicine) Physician | — | NULL | — |
| 207PE0004X | Emergency Medical Services (Emergency Medicine) Physician | — | — | — |
| 207V00000X | Obstetrics & Gynecology Physician | — | NULL | Yes |
| 207V00000X | Obstetrics & Gynecology Physician | — | — | Yes |

## Other

- **Enumeration date:** 01/10/2023
- **Last updated:** 01/10/2023