Provider Demographics
NPI:1679527311
Name:DIAMENT, MATTHEW A (MD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:A
Last Name:DIAMENT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:545 ELMONT RD
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-4002
Mailing Address - Country:US
Mailing Address - Phone:516-328-7200
Mailing Address - Fax:516-977-2874
Practice Address - Street 1:227 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:HEWLETT
Practice Address - State:NY
Practice Address - Zip Code:11557-1902
Practice Address - Country:US
Practice Address - Phone:516-295-5500
Practice Address - Fax:516-569-8225
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2015-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2393282085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02745893Medicaid
NY06544RMedicare PIN
NY75R491Medicare PIN
NY02745893Medicaid
NYI52363Medicare UPIN
NY07075PMedicare PIN