Diaz, Jennifer Marie

Diaz, Jennifer Marie is an individual health care provider with primary practice located at 1500 Route 112 Bldg. 4 - 2Nd Floor, Port Jefferson Station NY 11776-8054. She recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Pediatrics, Allopathic & Osteopathic Physicians / Allergy & Immunology. Allopathic & Osteopathic Physicians / Allergy & Immunology is her primary health care specialty. Diaz, Jennifer Marie can be contacted via phone (631) 828-7001.

Contact Information

Primary practice address
1500 Route 112 Bldg. 4 - 2Nd Floor Port Jefferson Station NY 11776-8054
Phone: (631) 828-7001
Fax: (631) 928-0185
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatrics 208000000X 2511881 New York
Allopathic & Osteopathic Physicians / Allergy & Immunology 207K00000X 251188 New York

Profile Details

NPI number 1053636431
LBN Legal business name Diaz, Jennifer Marie
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 29th, 2010
Last updated Apr 2nd, 2019 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1053636431 NPPES
New York Other P01438980 RAILROAD MEDICARE PIN

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