MEDICARE: KINGS DIAGNOSTICS INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist

General Provider Information

NPI Number	:	1487126397
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KINGS DIAGNOSTICS INC

Provider Business Mailing Address
First Line	:	10 CLINTON ST APT 8R
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11201-2709
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2327 83RD ST STE D
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11214-2749
Country	:	US
Telephone Number	:	347-922-5970
Fax Number	:	347-657-5570

Authorized Official
Title or Position	:	MANAGER
Name	:	OLEKSANDR SHEVCHENKO
Credential	:
Telephone Number	:	646-204-4460

Provider Enumeration Date	:	12/18/2018
Last Update Date	:	12/18/2018

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Directions to “KINGS DIAGNOSTICS INC ” Practice Location

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