MEDICARE: YANA'S DIAGNOSTIC TESTING INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR0208X	Mobile Radiology Clinic/Center

General Provider Information

NPI Number	:	1588807564
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YANA'S DIAGNOSTIC TESTING INC

Provider Business Mailing Address
First Line	:	197 ROUTE 18 STE 300
Second Line	:
City	:	EAST BRUNSWICK
State	:	NJ
Zip	:	08816-1440
Country	:	US
Telephone Number	:	917-407-6858
Fax Number	:

Provider Business Practice Location Address
First Line	:	197 ROUTE 18 STE 300
Second Line	:
City	:	EAST BRUNSWICK
State	:	NJ
Zip	:	08816-1440
Country	:	US
Telephone Number	:	917-407-6858
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ELLA IKHILEVSKY
Credential	:
Telephone Number	:	917-407-6858

Provider Enumeration Date	:	04/07/2009
Last Update Date	:	04/07/2009

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