Provider Demographics
NPI:1619215852
Name:SARNELLE DIAGNOSTIC LLC
Entity Type:Organization
Organization Name:SARNELLE DIAGNOSTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:SARNELLE
Authorized Official - Suffix:
Authorized Official - Credentials:M D,
Authorized Official - Phone:732-264-9437
Mailing Address - Street 1:PO BOX 230306
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-0306
Mailing Address - Country:US
Mailing Address - Phone:732-264-9437
Mailing Address - Fax:
Practice Address - Street 1:15 DAVIS CT
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08836-2316
Practice Address - Country:US
Practice Address - Phone:732-264-2141
Practice Address - Fax:732-264-7846
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-23
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04021900207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB17894Medicare UPIN