Provider Demographics
NPI:1023327616
Name:ELECTRO DIAGNOSTICS
Entity type:Organization
Organization Name:ELECTRO DIAGNOSTICS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GRIGORI
Authorized Official - Middle Name:
Authorized Official - Last Name:KOMISSARCHUK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-702-0977
Mailing Address - Street 1:105 NEPTUNE AVE 1ST FLOOR
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-5350
Mailing Address - Country:US
Mailing Address - Phone:347-702-0977
Mailing Address - Fax:
Practice Address - Street 1:105 NEPTUNE AVE FL 1
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-5350
Practice Address - Country:US
Practice Address - Phone:347-702-0977
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-29
Last Update Date:2010-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherGroup - Single Specialty