Provider Demographics
NPI:1396053450
Name:PREVENT DIAGNOSTIC CORP
Entity type:Organization
Organization Name:PREVENT DIAGNOSTIC CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GAMZE
Authorized Official - Middle Name:
Authorized Official - Last Name:YANIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-676-4336
Mailing Address - Street 1:205 WOOD RD
Mailing Address - Street 2:
Mailing Address - City:LAKE GROVE
Mailing Address - State:NY
Mailing Address - Zip Code:11755-1856
Mailing Address - Country:US
Mailing Address - Phone:631-676-4336
Mailing Address - Fax:631-676-4337
Practice Address - Street 1:205 WOOD RD
Practice Address - Street 2:
Practice Address - City:LAKE GROVE
Practice Address - State:NY
Practice Address - Zip Code:11755-1856
Practice Address - Country:US
Practice Address - Phone:631-676-4336
Practice Address - Fax:631-676-4337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-22
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty