Organization
GREGORY J DIEHL MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GREGORY J DIEHL MD (PRESIDENT)
(631) 476-7300
Entity
Organization
Contact information
Practice address
11 MEDICAL DR, SUITE B, PORT JEFFERSON STATION, NY 11776-1589
(631) 476-7300
(631) 476-7304
Mailing address
11 MEDICAL DR, SUITE B, PORT JEFFERSON STATION, NY 11776-1589
(631) 476-7300
(631) 476-7304
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
1902162
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1447249214
NPI
NY
Enumeration date
02/12/2011
Last updated
02/12/2011
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