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General NPI Number Information
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NPI Number | 1245423508
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Entity Type | Organization
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Legal Business Name | NORTH SHORE DIAGNOSTIC MEDICAL TESTING PC
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Dates
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Enumeration Date | 08/21/2007
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Last Update Date | 08/21/2007
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Provider Practice Location Address
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Address Line | 2435 VICTORY BLVD
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City | STATEN ISLAND
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State | NY
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Zip | 10314
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Country | US
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Telephone | 718-370-3730
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Fax | 718-370-9783
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Provider Business Mailing Address
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Address Line | 2435 VICTORY BLVD
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City | STATEN ISLAND
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State | NY
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Zip | 10314
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Country | US
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Telephone | 718-370-3730
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Fax | 718-370-9783
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Authorized Official
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Title or Position | PHYSICIAN PRESIDENT
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Name | FRANK S SCABURI III
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Credential | DO
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Telephone | 718-370-3730
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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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