Provider Demographics
NPI:1417023748
Name:SPECIALIZED DIAGNOSTICS LLC
Entity Type:Organization
Organization Name:SPECIALIZED DIAGNOSTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:N
Authorized Official - Last Name:BOROS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-427-2829
Mailing Address - Street 1:3349 RIDGELAKE DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002-3851
Mailing Address - Country:US
Mailing Address - Phone:504-427-2829
Mailing Address - Fax:504-347-2328
Practice Address - Street 1:3349 RIDGELAKE DR
Practice Address - Street 2:SUITE 104
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-3851
Practice Address - Country:US
Practice Address - Phone:504-427-2829
Practice Address - Fax:504-347-2328
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty