Healthcare Provider Details

I. General information

NPI: 1396353298
Provider Name (Legal Business Name): HEALTH FIRST DIAGNOSTICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2020
Last Update Date: 07/16/2020
Certification Date: 07/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 COLONIAL DR STE 108
MARGATE FL
33063-5672
US

IV. Provider business mailing address

445 FACTORY ST
WATERTOWN NY
13601-2729
US

V. Phone/Fax

Practice location:
  • Phone: 315-474-0240
  • Fax:
Mailing address:
  • Phone: 315-782-4207
  • Fax: 315-782-8699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

Name: CHARLOTTE SMITH
Title or Position: CREDENTIALING
Credential:
Phone: 315-782-4207