Provider Demographics
NPI:1336497072
Name:SYNERGY DIAGNOSTIC LABORATORY INC
Entity Type:Organization
Organization Name:SYNERGY DIAGNOSTIC LABORATORY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:MUSKAT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-581-3959
Mailing Address - Street 1:4081 SW 47TH AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33314-4008
Mailing Address - Country:US
Mailing Address - Phone:954-581-3959
Mailing Address - Fax:954-541-3952
Practice Address - Street 1:4081 SW 47TH AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33314-4008
Practice Address - Country:US
Practice Address - Phone:954-581-3959
Practice Address - Fax:954-530-6331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-28
Last Update Date:2020-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLGZ406Medicare PIN