=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447061346
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NYS DIAGNOSTICS & SUPPLY, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/20/2025
-----------------------------------------------------
Last Update Date | 11/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 121 CONGRESSIONAL LN STE 701
-----------------------------------------------------
City | ROCKVILLE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20852-1562
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 240-299-6339
-----------------------------------------------------
Fax | 240-238-6787
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 121 CONGRESSIONAL LN STE 701
-----------------------------------------------------
City | ROCKVILLE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20852-1562
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 240-299-6339
-----------------------------------------------------
Fax | 240-238-6787
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MINATA SADDY
-----------------------------------------------------
Credential | MLS, MHA
-----------------------------------------------------
Telephone | 443-430-0204
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------