Individual
GREGORY JOHN DIEHL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1500 ROUTE 112 BLDG # 10, PORT JEFFERSON STATION, NY 11776
(631) 476-7300
(631) 476-7304
Mailing address
1500 ROUTE 112, BLDG 10, PORT JEFFERSON STATION, NY 11776-3184
(631) 476-7300
(631) 476-7304
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
1902162
NY
2082S0105X
Surgery of the Hand (Plastic Surgery) Physician
1902162
NY
Other
Enumeration date
10/14/2005
Last updated
05/20/2020
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