Provider Demographics
NPI:1346672961
Name:UNIVERSAL DIAGNOSTICS, LLC.
Entity Type:Organization
Organization Name:UNIVERSAL DIAGNOSTICS, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JANIK
Authorized Official - Middle Name:
Authorized Official - Last Name:IZRAEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-628-5009
Mailing Address - Street 1:2420 KNAPP ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-1006
Mailing Address - Country:US
Mailing Address - Phone:718-841-7472
Mailing Address - Fax:718-332-3663
Practice Address - Street 1:2420 KNAPP ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-1006
Practice Address - Country:US
Practice Address - Phone:888-826-3349
Practice Address - Fax:888-826-3349
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-06
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY8782OtherPFI
NY33D2061409OtherCLIA