Provider Demographics
NPI:1093191900
Name:ADVANCED DIAGNOSTIC LLC
Entity Type:Organization
Organization Name:ADVANCED DIAGNOSTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSOCIATE PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:ZOLLICOFFER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-831-3193
Mailing Address - Street 1:13876 SW 56TH ST
Mailing Address - Street 2:SUITE 257
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-6021
Mailing Address - Country:US
Mailing Address - Phone:305-831-3193
Mailing Address - Fax:305-602-9828
Practice Address - Street 1:13876 SW 56TH ST
Practice Address - Street 2:SUITE 257
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-6021
Practice Address - Country:US
Practice Address - Phone:305-831-3193
Practice Address - Fax:305-602-9828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-03
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5228247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherGroup - Single Specialty