Provider Demographics
NPI:1164766986
Name:STEADFAST SPECIFICS INC
Entity Type:Organization
Organization Name:STEADFAST SPECIFICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICA MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TIMUR
Authorized Official - Middle Name:
Authorized Official - Last Name:TANKHOYEV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-572-4297
Mailing Address - Street 1:1637 E 17TH ST
Mailing Address - Street 2:1LT
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-1247
Mailing Address - Country:US
Mailing Address - Phone:917-572-4297
Mailing Address - Fax:877-287-6325
Practice Address - Street 1:1725 E 12TH ST
Practice Address - Street 2:SUITE # 301
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-1028
Practice Address - Country:US
Practice Address - Phone:718-336-1909
Practice Address - Fax:718-336-1929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-16
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY33D2034114291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory