NPIMap

Organization Active NPI

Lifeline Medical Testing PLLC

  • Pulmonary Disease Physician
  • New York, NY
National Provider Identifier
1114634482
Registry record updated Nov 4, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pulmonary Disease PhysicianTaxonomy code 207RP1001X
Legal business name
LIFELINE MEDICAL TESTING PLLC
Practice address
1041 3Rd Ave # 203
New York, NY 10065-8114
Phone
(212) 583-2969
NPI assigned
Nov 4, 2022
Last updated
Nov 4, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 4, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Diego Diaz, MDNPI 1942270467
Title
Medical Director/Ceo
Phone
(917) 678-8400

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pulmonary Disease PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RP1001X Primary

Addresses

Primary practice location

1041 3Rd Ave # 203
New York, NY 10065-8114

Mailing address

40 Ormond St
Dix Hills, NY 11746-6333

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230421002138 NY Part B Supplier - Clinic/Group Practice 1557726767 Receives reassigned benefits from 2 practitioners
Practice locations: Dix Hills, NY

National Provider Directory

National Provider Directory

Locations

1041 3rd Ave
#203
New York, NY 10065
Phone (212) 583-2969

Practitioners & affiliated clinicians

Practitioners 33

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 33

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1667520000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1667520000000",
    "number": "1114634482",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "40 ORMOND ST",
            "city": "DIX HILLS",
            "state": "NY",
            "postal_code": "117466333"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1041 3RD AVE # 203",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100658114",
            "telephone_number": "212-583-2969"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFELINE MEDICAL TESTING PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-11-04",
        "last_updated": "2022-11-04",
        "certification_date": "2022-11-04",
        "status": "A",
        "authorized_official_last_name": "DIAZ",
        "authorized_official_first_name": "DIEGO",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR/CEO",
        "authorized_official_telephone_number": "917-678-8400",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RP1001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.