Provider Demographics
NPI:1689847857
Name:EKOSCIENCE DIAGNOSTICS, LLC
Entity Type:Organization
Organization Name:EKOSCIENCE DIAGNOSTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:FALDNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-671-6300
Mailing Address - Street 1:7056 N OAKLEY AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60645-3426
Mailing Address - Country:US
Mailing Address - Phone:773-671-6300
Mailing Address - Fax:
Practice Address - Street 1:7056 N OAKLEY AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60645-3426
Practice Address - Country:US
Practice Address - Phone:773-671-6300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-09
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL217172Medicare PIN