Healthcare Provider Details

I. General information

NPI: 1104215722
Provider Name (Legal Business Name): DIAGNOSTIX OF NY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2015
Last Update Date: 01/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11940 METROPOLITAN AVE UNIT CU2 - SUITE 107
KEW GARDENS NY
11415-2600
US

IV. Provider business mailing address

11940 METROPOLITAN AVE UNIT CU2 - SUITE 107
KEW GARDENS NY
11415-2600
US

V. Phone/Fax

Practice location:
  • Phone: 347-871-5754
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARINA RABINOVICH
Title or Position: PRESIDENT
Credential:
Phone: 347-871-5754