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General NPI Number Information
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NPI Number | 1043492374
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Entity Type | Organization
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Legal Business Name | N. S. SO ISLAND DIAG GRP
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Dates
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Enumeration Date | 11/28/2007
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Last Update Date | 05/29/2008
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Provider Practice Location Address
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Address Line | 9009 ROCKAWAY BCH BLVD
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City | ROCKAWAY BEACH
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State | NY
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Zip | 11693-1531
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Country | US
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Telephone | 718-474-9631
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 549
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City | CEDARHURST
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State | NY
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Zip | 11516-0549
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Country | US
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Telephone | 718-471-5400
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Fax | 718-382-5400
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Authorized Official
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Title or Position | VP
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Name | MRS. NORMA L BUHRTS
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Credential |
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Telephone | 239-210-0132
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 33D0875629
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License Number State | NY
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