Provider Demographics
NPI:1760930697
Name:DYNIX DIAGNOSTIX
Entity Type:Organization
Organization Name:DYNIX DIAGNOSTIX
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ALTERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-589-0579
Mailing Address - Street 1:2260 N US HIGHWAY 1
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34946-8913
Mailing Address - Country:US
Mailing Address - Phone:844-514-8158
Mailing Address - Fax:
Practice Address - Street 1:2260 N US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34946-8913
Practice Address - Country:US
Practice Address - Phone:844-514-8158
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-20
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory