Provider Demographics
NPI:1801860697
Name:IMMCO DIAGNOSTICS, INC
Entity Type:Organization
Organization Name:IMMCO DIAGNOSTICS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VIJAY
Authorized Official - Middle Name:
Authorized Official - Last Name:KUMAR
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:716-691-0091
Mailing Address - Street 1:60 PINEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14228-2120
Mailing Address - Country:US
Mailing Address - Phone:716-691-0091
Mailing Address - Fax:716-691-0466
Practice Address - Street 1:60 PINEVIEW DR
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14228-2120
Practice Address - Country:US
Practice Address - Phone:716-691-0091
Practice Address - Fax:716-691-0466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYKUMAV1291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory