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General NPI Number Information
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NPI Number | 1235894148
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Entity Type | Organization
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Legal Business Name | MIRIMUS, INC.
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Dates
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Enumeration Date | 11/04/2021
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Last Update Date | 11/04/2021
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Provider Practice Location Address
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Address Line | 760 PARKSIDE AVE STE 206
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City | BROOKLYN
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State | NY
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Zip | 11226-1785
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Country | US
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Telephone | 929-377-3744
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Fax |
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Provider Business Mailing Address
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Address Line | 760 PARKSIDE AVE STE 206
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City | BROOKLYN
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State | NY
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Zip | 11226-1785
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Country | US
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Telephone | 929-377-3744
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Fax |
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Authorized Official
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Title or Position | FOUNDER & CEO
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Name | PREM PREMSRIRUT
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Credential |
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Telephone | 929-377-3744
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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 |
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License Number State |
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