Provider Demographics
NPI:1497423198
Name:SUPERB DIAGNOSTICS, LLC
Entity Type:Organization
Organization Name:SUPERB DIAGNOSTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BORIS
Authorized Official - Middle Name:
Authorized Official - Last Name:KATAVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:551-209-0080
Mailing Address - Street 1:810 MAIN ST STE 2
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-4802
Mailing Address - Country:US
Mailing Address - Phone:551-209-0080
Mailing Address - Fax:
Practice Address - Street 1:810 MAIN ST STE 2
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-4802
Practice Address - Country:US
Practice Address - Phone:551-209-0080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-30
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory