Provider Demographics
NPI:1922430057
Name:SOLARIS DIAGNOSTIC CENTER, INC
Entity Type:Organization
Organization Name:SOLARIS DIAGNOSTIC CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LERIDO
Authorized Official - Middle Name:
Authorized Official - Last Name:GUERRERO
Authorized Official - Suffix:
Authorized Official - Credentials:MR
Authorized Official - Phone:917-704-3087
Mailing Address - Street 1:PO BOX 1043
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10040-0812
Mailing Address - Country:US
Mailing Address - Phone:212-781-5891
Mailing Address - Fax:212-781-6053
Practice Address - Street 1:129 WADSWORTH AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-4828
Practice Address - Country:US
Practice Address - Phone:212-781-5891
Practice Address - Fax:212-781-6053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-31
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY=========OtherTAX ID NUMBER