Individual
DR. JILL R DIETZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1111 FRANKLIN AVE, GARDEN CITY, NY 11530-1617
(516) 663-1950
(516) 741-3562
Mailing address
1111 FRANKLIN AVE, GARDEN CITY, NY 11530-1617
(516) 663-1950
(516) 741-3562
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
333332
NY
208600000X
Surgery Physician
MD474935
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
15405815
CAQH
—
Enumeration date
07/17/2006
Last updated
10/10/2024
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