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General NPI Number Information
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NPI Number | 1275137648
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Entity Type | Organization
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Legal Business Name | LAGUARDIA DIAGNOSTICS INC
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Dates
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Enumeration Date | 11/25/2020
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Last Update Date | 07/15/2024
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Provider Practice Location Address
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Address Line | 250 AVENUE X FL 2
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City | BROOKLYN
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State | NY
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Zip | 11223-5940
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Country | US
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Telephone | 347-922-5970
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Fax |
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Provider Business Mailing Address
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Address Line | 10 CLINTON ST APT 8R
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City | BROOKLYN
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State | NY
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Zip | 11201-2709
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Country | US
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Telephone | 347-922-5970
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | OLEKSANDR SHEVCHENKO
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Credential |
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Telephone | 646-204-4460
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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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