Provider Demographics
NPI:1205231107
Name:EAST COAST DIAGNOSTICS LLC
Entity Type:Organization
Organization Name:EAST COAST DIAGNOSTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LOUISA
Authorized Official - Middle Name:
Authorized Official - Last Name:KIPERVAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-967-1079
Mailing Address - Street 1:2840 PINE RD
Mailing Address - Street 2:SUITE D1
Mailing Address - City:HUNTINGDON VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19006-4258
Mailing Address - Country:US
Mailing Address - Phone:215-967-1079
Mailing Address - Fax:
Practice Address - Street 1:2021 MARTIN LUTHER KING JR AVE SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-7007
Practice Address - Country:US
Practice Address - Phone:215-967-1079
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-04
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile