Provider Demographics
NPI:1003653577
Name:PRESTIGE DATA SOLUTIONS
Entity type:Organization
Organization Name:PRESTIGE DATA SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED PHLEBOTOMIST
Authorized Official - Prefix:
Authorized Official - First Name:SHANIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-581-7526
Mailing Address - Street 1:22411 135TH AVE
Mailing Address - Street 2:
Mailing Address - City:LAURELTON
Mailing Address - State:NY
Mailing Address - Zip Code:11413-2013
Mailing Address - Country:US
Mailing Address - Phone:718-581-7526
Mailing Address - Fax:
Practice Address - Street 1:22411 135TH AVE
Practice Address - Street 2:
Practice Address - City:LAURELTON
Practice Address - State:NY
Practice Address - Zip Code:11413-2013
Practice Address - Country:US
Practice Address - Phone:718-581-7526
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-11
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center