Provider Demographics
NPI:1609450659
Name:SALUTEM DIAGNOSTICS LLC
Entity Type:Organization
Organization Name:SALUTEM DIAGNOSTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ARCHIL
Authorized Official - Middle Name:
Authorized Official - Last Name:ARJEVANIDZE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-570-8639
Mailing Address - Street 1:187 MERRILL AVE FL 1
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-3239
Mailing Address - Country:US
Mailing Address - Phone:347-570-8639
Mailing Address - Fax:
Practice Address - Street 1:187 MERRILL AVE FL 1
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-3239
Practice Address - Country:US
Practice Address - Phone:347-570-8639
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-06
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty