Provider Demographics
NPI:1689950164
Name:PREMIER DIAGNOSTICS LLC
Entity Type:Organization
Organization Name:PREMIER DIAGNOSTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JOSH
Authorized Official - Middle Name:
Authorized Official - Last Name:GREENBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-612-4884
Mailing Address - Street 1:395 PEARSALL AVE
Mailing Address - Street 2:
Mailing Address - City:CEDARHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11516-1828
Mailing Address - Country:US
Mailing Address - Phone:516-612-4884
Mailing Address - Fax:516-612-4883
Practice Address - Street 1:395 PEARSALL AVE
Practice Address - Street 2:
Practice Address - City:CEDARHURST
Practice Address - State:NY
Practice Address - Zip Code:11516-1828
Practice Address - Country:US
Practice Address - Phone:516-612-4884
Practice Address - Fax:516-612-4883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-27
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center