Provider Demographics
NPI:1639543812
Name:HEARTLINE DIAGNOSTICS LLC
Entity Type:Organization
Organization Name:HEARTLINE DIAGNOSTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SAM
Authorized Official - Middle Name:
Authorized Official - Last Name:GORMEZANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-375-2105
Mailing Address - Street 1:33 W HAWTHORNE AVE
Mailing Address - Street 2:SUITE 22
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-6207
Mailing Address - Country:US
Mailing Address - Phone:516-812-8844
Mailing Address - Fax:
Practice Address - Street 1:33 W HAWTHORNE AVE
Practice Address - Street 2:SUITE 22
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580-6207
Practice Address - Country:US
Practice Address - Phone:516-812-8844
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-25
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory