Healthcare Provider Details

I. General information

NPI: 1104608728
Provider Name (Legal Business Name): SYNERGY DIAGNOSTICS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2023
Last Update Date: 10/18/2023
Certification Date: 10/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 E ATLANTIC BLVD
POMPANO BEACH FL
33060-6343
US

IV. Provider business mailing address

611 E ATLANTIC BLVD
POMPANO BEACH FL
33060-6343
US

V. Phone/Fax

Practice location:
  • Phone: 954-873-0650
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name: DR. ROSS PINE
Title or Position: PRESIDENT
Credential: DC
Phone: 954-873-0650