Provider Demographics
NPI:1518411412
Name:TRISTATE NY DIAGNOSTICS INC
Entity Type:Organization
Organization Name:TRISTATE NY DIAGNOSTICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAMAZ
Authorized Official - Middle Name:
Authorized Official - Last Name:MITAISHVILI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-336-2753
Mailing Address - Street 1:2464 CONEY ISLAND AVE
Mailing Address - Street 2:3 FLOOR
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-5022
Mailing Address - Country:US
Mailing Address - Phone:718-336-2753
Mailing Address - Fax:718-339-0170
Practice Address - Street 1:2464 CONEY ISLAND AVE
Practice Address - Street 2:3 FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-5022
Practice Address - Country:US
Practice Address - Phone:718-336-2753
Practice Address - Fax:718-339-0170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-09
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty