Provider Demographics
NPI:1790430080
Name:DEPENDABLE DIAGNOSTICS
Entity Type:Organization
Organization Name:DEPENDABLE DIAGNOSTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:SELINA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRAY
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, PMH-C
Authorized Official - Phone:732-306-8461
Mailing Address - Street 1:335 GEORGE ST STE 4-1016
Mailing Address - Street 2:
Mailing Address - City:NEW BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08901-2036
Mailing Address - Country:US
Mailing Address - Phone:732-306-8461
Mailing Address - Fax:
Practice Address - Street 1:73 LLOYD ST
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08817-5254
Practice Address - Country:US
Practice Address - Phone:732-306-8461
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-16
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory