Provider Demographics
NPI:1497372916
Name:WAVE SCIENTIFIC LLC
Entity Type:Organization
Organization Name:WAVE SCIENTIFIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ESQ
Authorized Official - Prefix:
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:J
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:ESQ
Authorized Official - Phone:561-482-2400
Mailing Address - Street 1:12300 ALT A1A STE 105
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-2206
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12300 ALT A1A STE 105
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-2206
Practice Address - Country:US
Practice Address - Phone:561-678-2311
Practice Address - Fax:561-283-0511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-30
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory