Provider Demographics
NPI:1982659520
Name:A J DIAGNOSTIC INC
Entity Type:Organization
Organization Name:A J DIAGNOSTIC INC
Other - Org Name:SAME AS ABOVE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:VOSKY
Authorized Official - Middle Name:
Authorized Official - Last Name:TSEROUNIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-246-1956
Mailing Address - Street 1:318 1/2 N BRAND BLVD
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203-2304
Mailing Address - Country:US
Mailing Address - Phone:818-246-1956
Mailing Address - Fax:818-246-0161
Practice Address - Street 1:318 1/2 N BRAND BLVD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-2304
Practice Address - Country:US
Practice Address - Phone:818-246-1956
Practice Address - Fax:818-246-0161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CATG508Medicare ID - Type UnspecifiedIDTF