Provider Demographics
NPI:1760583975
Name:DYNAMIC QUALITY SERVICES INC
Entity Type:Organization
Organization Name:DYNAMIC QUALITY SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BORIS
Authorized Official - Middle Name:
Authorized Official - Last Name:LIKHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-935-0081
Mailing Address - Street 1:69 LENT DRIVE
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-6433
Mailing Address - Country:US
Mailing Address - Phone:516-935-0081
Mailing Address - Fax:
Practice Address - Street 1:69 LENT DR
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-6433
Practice Address - Country:US
Practice Address - Phone:516-935-0081
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY293D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY97Z651Medicare ID - Type Unspecified