=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720426992
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PRECISION DIAGNOSTICS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/11/2013
-----------------------------------------------------
Last Update Date | 05/27/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 80 HAZLET AVE UNIT # 11
-----------------------------------------------------
City | HAZLET
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07730-1623
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-888-1997
-----------------------------------------------------
Fax | 732-888-1776
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 80 HAZLET AVE UNIT # 11
-----------------------------------------------------
City | HAZLET
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07730-1623
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-888-1997
-----------------------------------------------------
Fax | 732-888-1776
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | ROBERTO TAJANLANGIT JR.
-----------------------------------------------------
Credential | RN BSN
-----------------------------------------------------
Telephone | 732-888-1997
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number | 31D2058237
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------