Provider Demographics
NPI:1972986297
Name:PRIME DIAGNOSIS MEDICAL P.A.
Entity Type:Organization
Organization Name:PRIME DIAGNOSIS MEDICAL P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VASILIKY
Authorized Official - Middle Name:
Authorized Official - Last Name:TSIROGIANNIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:551-482-6186
Mailing Address - Street 1:1325 PATERSON PLANK RD
Mailing Address - Street 2:
Mailing Address - City:SECAUCUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07094-3746
Mailing Address - Country:US
Mailing Address - Phone:201-583-5232
Mailing Address - Fax:201-351-4016
Practice Address - Street 1:1325 PATERSON PLANK RD
Practice Address - Street 2:
Practice Address - City:SECAUCUS
Practice Address - State:NJ
Practice Address - Zip Code:07094-3746
Practice Address - Country:US
Practice Address - Phone:201-583-5232
Practice Address - Fax:201-351-4016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-06
Last Update Date:2016-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08733800207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ324655Medicaid
NJ260105Medicare PIN