Healthcare Provider Details

I. General information

NPI: 1104216605
Provider Name (Legal Business Name): PHR DIAGNOSTICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2015
Last Update Date: 12/22/2020
Certification Date: 12/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13601 PRESTON RD STE 1050E
DALLAS TX
75240-4927
US

IV. Provider business mailing address

34 SANDY BROOK DR
SPRING VALLEY NY
10977-1214
US

V. Phone/Fax

Practice location:
  • Phone: 469-913-7042
  • Fax: 516-534-2074
Mailing address:
  • Phone: 347-210-6969
  • Fax: 214-396-9441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number StateTX

VIII. Authorized Official

Name: MR. DAVID SOBEL
Title or Position: OWNER
Credential:
Phone: 347-210-6969