Individual
DR. KEITH THOMAS DIAZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
682 FOREST AVE, STATEN ISLAND, NY 10310-2507
(347) 575-9865
Mailing address
474 BEDFORD AVE, STATEN ISLAND, NY 10306-5424
(347) 575-9865
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
245968
NY
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
245968
NY
207RP1001X
Pulmonary Disease Physician
Primary
245968
NY
Other
Enumeration date
05/30/2008
Last updated
09/08/2014
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