Individual
JONATHAN DIAZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
1468 MADISON AVE, NEW YORK, NY 10029-6508
(212) 241-6500
Mailing address
23 MELBA ST, STATEN ISLAND, NY 10314-5334
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
431341
NY
Other
Enumeration date
07/16/2018
Last updated
07/16/2018
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