Healthcare Provider Details

I. General information

NPI: 1720075286
Provider Name (Legal Business Name): LIFECARE DIAGNOSTICS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2005
Last Update Date: 08/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1991 BALSLEY RD
SENECA FALLS NY
13148-9714
US

IV. Provider business mailing address

1991 BALSLEY RD
SENECA FALLS NY
13148-9714
US

V. Phone/Fax

Practice location:
  • Phone: 315-539-0237
  • Fax: 315-539-0940
Mailing address:
  • Phone: 315-539-9229
  • 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: DR. TIMOTHY J RYAN
Title or Position: OWNER
Credential: MD
Phone: 315-539-0237