Provider Demographics
NPI:1073690566
Name:TLC DIAGNOSTICS, LLC
Entity Type:Organization
Organization Name:TLC DIAGNOSTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:LAROSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-640-6535
Mailing Address - Street 1:50 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EAST ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11518-1929
Mailing Address - Country:US
Mailing Address - Phone:516-887-8870
Mailing Address - Fax:516-887-0175
Practice Address - Street 1:50 MAIN ST
Practice Address - Street 2:
Practice Address - City:EAST ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11518-1929
Practice Address - Country:US
Practice Address - Phone:516-887-8870
Practice Address - Fax:516-887-0175
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
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