Individual
JENNIFER MARIE DIAZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1500 ROUTE 112, BLDG. 4 - 2ND FLOOR, PORT JEFFERSON STATION, NY 11776-8054
(631) 828-7001
(631) 928-0185
Mailing address
660 WHITE PLAINS RD FL 4, TARRYTOWN, NY 10591-5139
(914) 984-2546
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
251188
NY
208000000X
Pediatrics Physician
2511881
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P01438980
RAILROAD MEDICARE PIN
NY
Enumeration date
03/29/2010
Last updated
04/02/2019
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