Provider Demographics
NPI:1811375827
Name:PREMIER DIAGNOSTIC TESTING, INC.
Entity Type:Organization
Organization Name:PREMIER DIAGNOSTIC TESTING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LEONID
Authorized Official - Middle Name:
Authorized Official - Last Name:KOSYAKOVSKIY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-369-5833
Mailing Address - Street 1:364 N COURTLAND ST
Mailing Address - Street 2:
Mailing Address - City:EAST STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18301-1930
Mailing Address - Country:US
Mailing Address - Phone:570-369-5833
Mailing Address - Fax:
Practice Address - Street 1:364 N COURTLAND ST
Practice Address - Street 2:
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-1930
Practice Address - Country:US
Practice Address - Phone:570-369-5833
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-11
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty