Provider Demographics
NPI:1376261040
Name:SPEK DIAGNOSTICS, INC
Entity Type:Organization
Organization Name:SPEK DIAGNOSTICS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:NATHAN
Authorized Official - Last Name:LENNBERG
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:208-854-9323
Mailing Address - Street 1:155 E 50TH ST
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:ID
Mailing Address - Zip Code:83714-1413
Mailing Address - Country:US
Mailing Address - Phone:208-609-3812
Mailing Address - Fax:
Practice Address - Street 1:155 E 50TH ST
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:ID
Practice Address - Zip Code:83714-1413
Practice Address - Country:US
Practice Address - Phone:208-854-9323
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-18
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathologyGroup - Single Specialty