Provider Demographics
NPI:1437782778
Name:MEDICAL SERRVICES OF LYNBROOK PC
Entity Type:Organization
Organization Name:MEDICAL SERRVICES OF LYNBROOK PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:
Authorized Official - Last Name:TKACSIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-503-0646
Mailing Address - Street 1:1101 STEWART AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-4833
Mailing Address - Country:US
Mailing Address - Phone:516-503-0646
Mailing Address - Fax:888-289-5601
Practice Address - Street 1:1101 STEWART AVE STE 100
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-4833
Practice Address - Country:US
Practice Address - Phone:516-503-0646
Practice Address - Fax:888-289-5601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-14
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnosticGroup - Multi-Specialty