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General NPI Number Information
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NPI Number | 1770883779
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Entity Type | Organization
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Legal Business Name | S & S DIAGNOSTIC SERVICES, INC
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Dates
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Enumeration Date | 10/25/2010
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Last Update Date | 10/25/2010
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Provider Practice Location Address
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Address Line | 3245 GROVE AVE SUITE 104
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City | BERWYN
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State | IL
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Zip | 60402-3474
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Country | US
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Telephone | 708-484-9761
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Fax | 708-484-7131
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Provider Business Mailing Address
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Address Line | 3245 GROVE AVE SUITE 104
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City | BERWYN
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State | IL
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Zip | 60402-3474
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Country | US
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Telephone | 708-484-9761
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Fax | 708-484-7131
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. MOHAMMED THASEEN
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Credential |
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Telephone | 708-484-9761
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 293D00000X
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Taxonomy Name | Physiological Laboratory
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License Number |
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License Number State |
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