MEDICARE: SALUTEM DIAGNOSTICS LLC

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	:	1609450659
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SALUTEM DIAGNOSTICS LLC

Provider Business Mailing Address
First Line	:	187 MERRILL AVE FL 1
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314-3239
Country	:	US
Telephone Number	:	347-570-8639
Fax Number	:

Provider Business Practice Location Address
First Line	:	187 MERRILL AVE FL 1
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314-3239
Country	:	US
Telephone Number	:	347-570-8639
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	ARCHIL ARJEVANIDZE
Credential	:
Telephone Number	:	347-570-8639

Provider Enumeration Date	:	05/06/2021
Last Update Date	:	05/06/2021

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Directions to “SALUTEM DIAGNOSTICS LLC ” Practice Location

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