Provider Demographics
NPI:1417286444
Name:DIAGNOSTIC ASSESSMENT, INC.
Entity Type:Organization
Organization Name:DIAGNOSTIC ASSESSMENT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDOLPH
Authorized Official - Middle Name:
Authorized Official - Last Name:CABAN
Authorized Official - Suffix:
Authorized Official - Credentials:SPECIAL EDUCATION
Authorized Official - Phone:718-734-1764
Mailing Address - Street 1:1641 3RD AVE
Mailing Address - Street 2:29DE
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-3623
Mailing Address - Country:US
Mailing Address - Phone:718-734-1764
Mailing Address - Fax:718-734-1764
Practice Address - Street 1:1641 3RD AVE
Practice Address - Street 2:29DE
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-3623
Practice Address - Country:US
Practice Address - Phone:718-734-1764
Practice Address - Fax:718-734-1764
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-22
Last Update Date:2012-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY11302252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency