Provider Demographics
NPI:1568407203
Name:NEW MILLENIUM MOBILE DIAGNOSTIC SERVICES
Entity Type:Organization
Organization Name:NEW MILLENIUM MOBILE DIAGNOSTIC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEKSANDR
Authorized Official - Middle Name:
Authorized Official - Last Name:BROMBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-387-5005
Mailing Address - Street 1:2500 WILSHIRE BLVD
Mailing Address - Street 2:SUITE # 1122
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057-4303
Mailing Address - Country:US
Mailing Address - Phone:213-387-5005
Mailing Address - Fax:213-387-5006
Practice Address - Street 1:2500 WILSHIRE BLVD
Practice Address - Street 2:SUITE # 1122
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-4303
Practice Address - Country:US
Practice Address - Phone:213-387-5005
Practice Address - Fax:213-387-5006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA293D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CATG411Medicare ID - Type UnspecifiedIDTF