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NPI Code Detail

MEDICARE: LIFECARE DIAGNOSTICS INC

MEDICARE: LIFECARE DIAGNOSTICS 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
1291U00000XClinical Medical Laboratory

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1720075286
Entity Type Code : Organization
Provider Name (Legal Business Name) : LIFECARE DIAGNOSTICS INC
Provider Business Mailing Address
First Line : 1991 BALSLEY RD
Second Line :
City : SENECA FALLS
State : NY
Zip : 13148-9714
Country : US
Telephone Number : 315-539-9229
Fax Number :
Provider Business Practice Location Address
First Line : 1991 BALSLEY RD
Second Line :
City : SENECA FALLS
State : NY
Zip : 13148-9714
Country : US
Telephone Number : 315-539-0237
Fax Number : 315-539-0940
Authorized Official
Title or Position : OWNER
Name : DR. TIMOTHY J RYAN
Credential : MD
Telephone Number : 315-539-0237
Provider Enumeration Date : 09/30/2005
Last Update Date : 08/07/2009

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Directions to “LIFECARE DIAGNOSTICS INC ” Practice Location

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