Healthcare Provider Details

I. General information

NPI: 1902480296
Provider Name (Legal Business Name): REOPEN DIAGNOSTICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2021
Last Update Date: 11/18/2021
Certification Date: 11/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4518 COURT SQ
LONG ISLAND CITY NY
11101-2955
US

IV. Provider business mailing address

4518 COURT SQ
LONG ISLAND CITY NY
11101-2955
US

V. Phone/Fax

Practice location:
  • Phone: 332-214-3323
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: JONATHAN BADAL
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 347-831-3555