Provider Demographics
NPI:1073219804
Name:NOVA DIAGNOSTIX LLC
Entity Type:Organization
Organization Name:NOVA DIAGNOSTIX LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MIZRACHI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-744-5433
Mailing Address - Street 1:4085 HEMLOCK LN
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32780-2822
Mailing Address - Country:US
Mailing Address - Phone:917-744-5433
Mailing Address - Fax:
Practice Address - Street 1:1601 W REYNOLDS ST STE 100
Practice Address - Street 2:
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33563-4748
Practice Address - Country:US
Practice Address - Phone:917-744-5433
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-02
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory