Provider Demographics
NPI:1205196656
Name:ADVANCED PREVENTIVE DIAGNOSTICS, INC
Entity Type:Organization
Organization Name:ADVANCED PREVENTIVE DIAGNOSTICS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SALEHUDDIN
Authorized Official - Middle Name:M
Authorized Official - Last Name:ISA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-264-7949
Mailing Address - Street 1:10373 DEMOCRACY LN STE B
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-2588
Mailing Address - Country:US
Mailing Address - Phone:347-264-7949
Mailing Address - Fax:571-442-8272
Practice Address - Street 1:10373 DEMOCRACY LN
Practice Address - Street 2:B
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-2586
Practice Address - Country:US
Practice Address - Phone:347-264-7949
Practice Address - Fax:571-442-8272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-19
Last Update Date:2012-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory