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General NPI Number Information
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NPI Number | 1063660991
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Entity Type | Organization
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Legal Business Name | ESSENTIAL DIAGNOSTICS PA
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Dates
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Enumeration Date | 09/04/2008
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Last Update Date | 09/04/2008
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Provider Practice Location Address
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Address Line | 141-F PELHAM DR SUITE 119
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City | COLUMBIA
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State | SC
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Zip | 29209
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Country | US
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Telephone | 803-223-9406
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Fax |
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Provider Business Mailing Address
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Address Line | 4611 HARD SCRABBLE RD STE 109 PMB# 330
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City | COLUMBIA
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State | SC
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Zip | 29229-9499
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Country | US
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Telephone | 803-223-9406
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DANIEL REIDMAN
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Credential | DO
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Telephone | 803-223-9406
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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