Provider Demographics
NPI:1942674890
Name:FAMILY DIAGNOSTICS LLC
Entity Type:Organization
Organization Name:FAMILY DIAGNOSTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FAUSTO
Authorized Official - Middle Name:LEANDRO
Authorized Official - Last Name:MINAYA CORREA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-553-9696
Mailing Address - Street 1:540 BISHOP DR
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CT
Mailing Address - Zip Code:06477-2522
Mailing Address - Country:US
Mailing Address - Phone:203-553-9696
Mailing Address - Fax:203-298-4185
Practice Address - Street 1:540 BISHOP DR
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CT
Practice Address - Zip Code:06477-2522
Practice Address - Country:US
Practice Address - Phone:203-553-9696
Practice Address - Fax:203-298-4185
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-16
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, MobileGroup - Single Specialty