Individual ProviderSamuel T DiazStudent in an Organized Health Care Education/Training ProgramStudent, Health CarePractice Address43 New Scotland Avenue, Dept. Of Emergency Medicine, Albany, NY 12208(518) 262-6455PECOS EnrollmentBased on the most recent information from CMS, provider Samuel T Diaz does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 3 days ago.Profile DetailsProvider ID1215687843Provider TypeIndividualFull NameDiaz, Samuel TCredentialDOGenderMaleSole ProprietorNoEnumeration Date3/26/2022Last Updated3/26/2022Contact InformationPractice LocationPractice Address43 New Scotland Avenue, Dept. Of Emergency Medicine, Albany, NY 12208Phone(518) 262-6455FaxUnlisted FaxMailing LocationMailing Address43 New Scotland Avenue, Dept. Of Emergency Medicine, Albany, NY 12208Phone(518) 262-6455FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode390200000XPrimaryDescriptionStudent in an Organized Health Care Education/Training ProgramStudent, Health CareLicense64588New York