Provider Demographics
NPI:1174856595
Name:DIAGNOSIS CENTER OF EXCELLENCE
Entity type:Organization
Organization Name:DIAGNOSIS CENTER OF EXCELLENCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:WAFIK
Authorized Official - Middle Name:
Authorized Official - Last Name:FAKHOURI
Authorized Official - Suffix:
Authorized Official - Credentials:TECHNICIAN
Authorized Official - Phone:201-424-4847
Mailing Address - Street 1:5005 BERGENLINE AVE
Mailing Address - Street 2:
Mailing Address - City:WEST NEW YORK
Mailing Address - State:NJ
Mailing Address - Zip Code:07093-5563
Mailing Address - Country:US
Mailing Address - Phone:201-864-2200
Mailing Address - Fax:201-864-9758
Practice Address - Street 1:575 LIBERTY AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07307-3910
Practice Address - Country:US
Practice Address - Phone:201-424-4847
Practice Address - Fax:201-656-6366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-16
Last Update Date:2009-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA54305174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty