Provider Demographics
NPI:1144292160
Name:DIAMOND, SEAN B (DC)
Entity type:Individual
Prefix:DR
First Name:SEAN
Middle Name:B
Last Name:DIAMOND
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 ADA DR
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-1402
Mailing Address - Country:US
Mailing Address - Phone:718-477-6633
Mailing Address - Fax:718-448-7530
Practice Address - Street 1:475 SAINT MARKS PL
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10301-2408
Practice Address - Country:US
Practice Address - Phone:718-448-7500
Practice Address - Fax:718-448-7530
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-03
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX009389111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYXAWNF1Medicare PIN
NYX5C061Medicare PIN