Provider Demographics
NPI:1851543193
Name:MR TEST CORP
Entity Type:Organization
Organization Name:MR TEST CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDUARD
Authorized Official - Middle Name:
Authorized Official - Last Name:MIKHAYLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-330-4855
Mailing Address - Street 1:2035 RALPH AVE
Mailing Address - Street 2:SUITE B2
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-5300
Mailing Address - Country:US
Mailing Address - Phone:646-330-4855
Mailing Address - Fax:
Practice Address - Street 1:2035 RALPH AVE
Practice Address - Street 2:SUITE B2
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-5300
Practice Address - Country:US
Practice Address - Phone:646-330-4855
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-17
Last Update Date:2009-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center