Provider Demographics
NPI:1366651820
Name:NEW DIMENSION PATIENT SERVICES, INC.
Entity Type:Organization
Organization Name:NEW DIMENSION PATIENT SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:HECTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:MERCADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-878-2730
Mailing Address - Street 1:PO BOX 456
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00613-0456
Mailing Address - Country:US
Mailing Address - Phone:787-878-2730
Mailing Address - Fax:787-879-8042
Practice Address - Street 1:52 AVE JOSE DE DIEGO
Practice Address - Street 2:
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612-4503
Practice Address - Country:US
Practice Address - Phone:787-878-2730
Practice Address - Fax:787-879-8042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR169291U00000X
PR169A291U00000X
PR291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR7000005983Medicare ID - Type UnspecifiedNUMERO REMITENTE