Provider Demographics
NPI:1275913311
Name:REPEAT DIAGNOSTICS INC
Entity Type:Organization
Organization Name:REPEAT DIAGNOSTICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/CO-FOUNDER
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:DE JONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:604-985-2609
Mailing Address - Street 1:267 WEST ESPLANADE AVENUE
Mailing Address - Street 2:SUITE 309
Mailing Address - City:NORTH VANCOUVER
Mailing Address - State:BC
Mailing Address - Zip Code:V7M 1A5
Mailing Address - Country:CA
Mailing Address - Phone:604-985-2609
Mailing Address - Fax:778-340-1144
Practice Address - Street 1:267 WEST ESPLANADE AVENUE
Practice Address - Street 2:SUITE 309
Practice Address - City:NORTH VANCOUVER
Practice Address - State:BC
Practice Address - Zip Code:V7M 1A5
Practice Address - Country:CA
Practice Address - Phone:604-985-2609
Practice Address - Fax:778-340-1144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-03
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZDAP291U00000X
CACOS 00800307291U00000X
MD1651291U00000X
FL94435291U00000X
NYPFI 8658291U00000X
PA032302291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory