Provider Demographics
NPI:1376308577
Name:ASD DIAGNOSTICS LLC
Entity Type:Organization
Organization Name:ASD DIAGNOSTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:BASSOUL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:833-822-2230
Mailing Address - Street 1:1037 ELM ST FL 2
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03101-1808
Mailing Address - Country:US
Mailing Address - Phone:833-822-2230
Mailing Address - Fax:
Practice Address - Street 1:175 PEARL ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-7508
Practice Address - Country:US
Practice Address - Phone:833-822-2230
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-16
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty