Provider Demographics
NPI:1063660991
Name:ESSENTIAL DIAGNOSTICS PA
Entity Type:Organization
Organization Name:ESSENTIAL DIAGNOSTICS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:REIDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:803-223-9406
Mailing Address - Street 1:4611 HARD SCRABBLE RD STE 109
Mailing Address - Street 2:PMB# 330
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-9499
Mailing Address - Country:US
Mailing Address - Phone:803-223-9406
Mailing Address - Fax:
Practice Address - Street 1:141-F PELHAM DR
Practice Address - Street 2:SUITE 119
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29209
Practice Address - Country:US
Practice Address - Phone:803-223-9406
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-04
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty