Provider Demographics
NPI:1720601347
Name:PDI HEALTH WV LLC
Entity Type:Organization
Organization Name:PDI HEALTH WV LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MENACEHM
Authorized Official - Middle Name:
Authorized Official - Last Name:TAUBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-749-9729
Mailing Address - Street 1:12 SPENCER ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11205
Mailing Address - Country:US
Mailing Address - Phone:800-749-9729
Mailing Address - Fax:
Practice Address - Street 1:126 E. BURKE STREET
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401
Practice Address - Country:US
Practice Address - Phone:800-749-9729
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-19
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile