MEDICARE: IMMCO 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
1	291U00000X	Clinical Medical Laboratory	KUMAV1	NY

General Provider Information

NPI Number	:	1801860697
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IMMCO DIAGNOSTICS, INC

Provider Business Mailing Address
First Line	:	60 PINEVIEW DR
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14228-2120
Country	:	US
Telephone Number	:	716-691-0091
Fax Number	:	716-691-0466

Provider Business Practice Location Address
First Line	:	60 PINEVIEW DR
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14228-2120
Country	:	US
Telephone Number	:	716-691-0091
Fax Number	:	716-691-0466

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. VIJAY KUMAR
Credential	:	PH.D.
Telephone Number	:	716-691-0091

Provider Enumeration Date	:	02/16/2006
Last Update Date	:	08/22/2020

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