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General NPI Number Information
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NPI Number | 1396053450
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Entity Type | Organization
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Legal Business Name | PREVENT DIAGNOSTIC CORP
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Dates
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Enumeration Date | 09/22/2010
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Last Update Date | 09/22/2010
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Provider Practice Location Address
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Address Line | 205 WOOD RD
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City | LAKE GROVE
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State | NY
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Zip | 11755-1856
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Country | US
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Telephone | 631-676-4336
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Fax | 631-676-4337
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Provider Business Mailing Address
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Address Line | 205 WOOD RD
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City | LAKE GROVE
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State | NY
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Zip | 11755-1856
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Country | US
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Telephone | 631-676-4336
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Fax | 631-676-4337
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Authorized Official
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Title or Position | PRESIDENT
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Name | GAMZE YANIK
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Credential |
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Telephone | 631-676-4336
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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