Provider Demographics
NPI:1598012429
Name:PHYSIOLOGIC ASSESSMENT SERVICES, LLC
Entity Type:Organization
Organization Name:PHYSIOLOGIC ASSESSMENT SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:
Authorized Official - Last Name:FRYE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-351-8459
Mailing Address - Street 1:PO BOX 28419
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10087-8419
Mailing Address - Country:US
Mailing Address - Phone:484-351-8459
Mailing Address - Fax:484-351-8810
Practice Address - Street 1:33 WOOD AVE S STE 600
Practice Address - Street 2:
Practice Address - City:ISELIN
Practice Address - State:NJ
Practice Address - Zip Code:08830-2717
Practice Address - Country:US
Practice Address - Phone:484-351-8459
Practice Address - Fax:484-351-8810
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEDSURANT HOLDINGS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-08-09
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty