Individual
DR. AGUSTIN DIAZ
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
433 57TH ST, WEST NEW YORK, NJ 07093-2119
(201) 863-2620
(201) 863-4804
Mailing address
433 57TH ST, WEST NEW YORK, NJ 07093-2119
(201) 863-2620
(201) 863-4804
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MA58115
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6428002
—
NJ
Enumeration date
03/22/2006
Last updated
07/08/2007
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