Provider Demographics
NPI:1548905003
Name:DIAZ AVENDANO, RENE ISAAC (MD)
Entity type:Individual
Prefix:MR
First Name:RENE
Middle Name:ISAAC
Last Name:DIAZ AVENDANO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 50TH AVE APT 28L
Mailing Address - Street 2:
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11101-5784
Mailing Address - Country:US
Mailing Address - Phone:917-587-3206
Mailing Address - Fax:
Practice Address - Street 1:227 MADISON ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10002-7537
Practice Address - Country:US
Practice Address - Phone:212-238-7724
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-29
Last Update Date:2025-07-11
Deactivation Date:2023-02-09
Deactivation Code:
Reactivation Date:2023-03-09
Provider Licenses
StateLicense IDTaxonomies
NY337491208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics