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Contact Information

JENNIFER M DIAZ, MD
1500 ROUTE 112
BLDG. 4 - 2ND FLOOR
PORT JEFFERSON STATION, NY11776-8054
 Phone: 631-828-7001
 Fax: 631-928-0185
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Allergy & Immunology

207K00000X 03 Physician/Allergy/ Immunology
 

Pediatrics

208000000X 37 Physician/Pediatric Medicine
Indicates primary specialty

NPI Profile & details for JENNIFER M DIAZ · (Female)

NPI Number 1053636431
Status Active
Credentials MD
Entity Individual
Enumeration date 03/29/2010
Last updated 04/02/2019 - About 7 years ago
Sole proprietor 1 No
Identifiers
  • NY License # 251188
  • NY License # 2511881
  • NY Other P01438980 RAILROAD MEDICARE PIN
Hospital affiliation(s)
  • JOHN T MATHER MEMORIAL HOSPITAL OF PORT JEFFERSON - (Acute Care)
    75 NORTH COUNTRY ROAD
    PORT JEFFERSON, NY 11777
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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