Provider Demographics
NPI:1700216256
Name:GREENLINE DIAGNOSTICS
Entity Type:Organization
Organization Name:GREENLINE DIAGNOSTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EUGENY
Authorized Official - Middle Name:
Authorized Official - Last Name:KIRZHNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-602-9116
Mailing Address - Street 1:971 N LA CIENEGA BLVD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90069-4790
Mailing Address - Country:US
Mailing Address - Phone:310-602-9116
Mailing Address - Fax:310-943-1727
Practice Address - Street 1:971 N LA CIENEGA BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90069-4790
Practice Address - Country:US
Practice Address - Phone:310-602-9116
Practice Address - Fax:310-943-1727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-20
Last Update Date:2013-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory