MEDICARE: APTIVE DIAGNOSTICS LLC

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	291U00000X	Clinical Medical Laboratory

General Provider Information

NPI Number	:	1730835786
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	APTIVE DIAGNOSTICS LLC

Provider Business Mailing Address
First Line	:	3920 N 29TH AVE
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33020-1010
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3920 N 29TH AVE
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33020-1010
Country	:	US
Telephone Number	:	346-466-8700
Fax Number	:	346-466-8701

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JACOB POLLAK
Credential	:
Telephone Number	:	346-466-8700

Provider Enumeration Date	:	02/28/2022
Last Update Date	:	07/10/2023

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