Luis Diaz, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

25MA12831900 Issued in NJ

Practice address

14-01 Broadway Ste B
Fair Lawn, NJ 07410-2001

Phone

(201) 791-4544

NPI assigned

Jan 20, 2019

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NJ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Internal Medicine

Education

Other, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Sovereign Medical Group LLCGroup PAC ID 1456535392, 20 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Sovereign Medical Group LLC

  • Urology Physician
  • Oradell, NJ
  • NPI 1710282082

  Internal Medicine

  Medicare reassignment Care Compare group NPD
• Bonleven Healthcare

  • Clinical Neurophysiology Physician
  • Maywood, NJ
  • NPI 1215817937
  Medicare reassignment NPD
• Sovereign Medical Group, LLC

  • Durable Medical Equipment & Medical Supplies
  • Glen Rock, NJ
  • NPI 1801266275
  NPD

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

{
    "created_epoch": "1547942400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1762732800000",
    "number": "1861966178",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "680 KINDERKAMACK RD STE 300",
            "city": "ORADELL",
            "state": "NJ",
            "postal_code": "076491600",
            "telephone_number": "305-781-9994"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14-01 BROADWAY STE B",
            "city": "FAIR LAWN",
            "state": "NJ",
            "postal_code": "074102001",
            "telephone_number": "201-791-4544"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7721 66th Dr",
            "address_purpose": "LOCATION",
            "city": "Middle Village",
            "state": "NY",
            "postal_code": "113792620",
            "country_code": "US",
            "telephone_number": "305-781-9994",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DIAZ",
        "first_name": "LUIS",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-01-20",
        "last_updated": "2025-11-10",
        "certification_date": "2025-11-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NJ",
            "license": "25MA12831900",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "P12405",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Helena Devaris, DDS
• Candace Devito, DC, MS
• Megan R Dezerga, LSW
• DG Rehab LLC
• Diagnostic Imaging Associates of North Jersey PA
• Alyssa Mary Dicarlantonio, LSW
• Katherina Antonova Dimova, PHARMD
• John Christopher Ding, D.M.D.
• Briana Dirusso, LSW
• DMR Rehabilitation

• Internal Medicine Physician in Fair Lawn, NJ
• Providers in Fair Lawn, NJ by specialty
• Internal Medicine Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.