Provider Demographics
NPI:1215232038
Name:INNOVATIVE DIAGNOSTIC SOLUTIONS LLC
Entity Type:Organization
Organization Name:INNOVATIVE DIAGNOSTIC SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NEAL
Authorized Official - Middle Name:
Authorized Official - Last Name:SKOP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-608-8787
Mailing Address - Street 1:587 WATERLOO CIR
Mailing Address - Street 2:
Mailing Address - City:BERWYN
Mailing Address - State:PA
Mailing Address - Zip Code:19312-3701
Mailing Address - Country:US
Mailing Address - Phone:610-608-8787
Mailing Address - Fax:
Practice Address - Street 1:587 WATERLOO CIR
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:PA
Practice Address - Zip Code:19312-3701
Practice Address - Country:US
Practice Address - Phone:610-608-8787
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-26
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD063627L207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty