Provider Demographics
NPI:1518277128
Name:ADVANCED DIAGNOSTIC INCORPORATED
Entity Type:Organization
Organization Name:ADVANCED DIAGNOSTIC INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:ZOLLICOFFER
Authorized Official - Suffix:
Authorized Official - Credentials:RPSGT, MD
Authorized Official - Phone:347-512-6859
Mailing Address - Street 1:PO BOX 121992
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33312-0034
Mailing Address - Country:US
Mailing Address - Phone:305-712-4324
Mailing Address - Fax:
Practice Address - Street 1:795 NW 42ND AVE
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-2179
Practice Address - Country:US
Practice Address - Phone:305-712-4324
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-15
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic