Healthcare Provider Details

I. General information

NPI: 1225431802
Provider Name (Legal Business Name): AP DIAGNOSTIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2014
Last Update Date: 12/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2792 OCEAN AVE UNIT 5A
BROOKLYN NY
11229-4729
US

IV. Provider business mailing address

2792 OCEAN AVE UNIT 5A
BROOKLYN NY
11229-4729
US

V. Phone/Fax

Practice location:
  • Phone: 718-975-0280
  • Fax: 718-975-0639
Mailing address:
  • Phone: 718-975-0280
  • Fax: 718-975-0639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225B00000X
TaxonomyPulmonary Function Technologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2279P1006X
TaxonomyPulmonary Function Technologist Registered Respiratory Therapist
License Number
License Number State

VIII. Authorized Official

Name: PAVEL TELYATNIKOV
Title or Position: PRESIDENT
Credential:
Phone: 718-975-0280