Healthcare Provider Details

I. General information

NPI: 1306418934
Provider Name (Legal Business Name): REOPEN DIAGNOSTICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2021
Last Update Date: 08/18/2021
Certification Date: 08/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 INNOVATION DR STE 150
IRVINE CA
92617-3037
US

IV. Provider business mailing address

430 E 29TH ST FL 12
NEW YORK NY
10016-8367
US

V. Phone/Fax

Practice location:
  • Phone: 651-253-7349
  • Fax:
Mailing address:
  • Phone: 541-253-7349
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: JONATHAN BADAL
Title or Position: CEO
Credential:
Phone: 347-831-3555