Healthcare Provider Details

I. General information

NPI: 1720214943
Provider Name (Legal Business Name): TBHC MEDICAL TESTING SERVICES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2009
Last Update Date: 02/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 DEKALB AVE
BROOKLYN NY
11201-5425
US

IV. Provider business mailing address

PO BOX 13573
PHILADELPHIA PA
19101-3573
US

V. Phone/Fax

Practice location:
  • Phone: 718-250-8205
  • Fax: 718-250-8155
Mailing address:
  • Phone: 718-250-6813
  • Fax: 718-250-6850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number
License Number State

VIII. Authorized Official

Name: PHILIP Q XIAO
Title or Position: SHAREHOLDER
Credential: MD
Phone: 718-250-8205