Provider Demographics
NPI:1740525906
Name:DESTINO MEDICAL DIAGNOSTICS PC
Entity type:Organization
Organization Name:DESTINO MEDICAL DIAGNOSTICS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SALVATORE
Authorized Official - Middle Name:
Authorized Official - Last Name:TRAZZERA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-834-9380
Mailing Address - Street 1:202 FALLWOOD PKWY
Mailing Address - Street 2:
Mailing Address - City:FARMINGDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11735-4929
Mailing Address - Country:US
Mailing Address - Phone:631-834-9380
Mailing Address - Fax:
Practice Address - Street 1:202 FALLWOOD PKWY
Practice Address - Street 2:
Practice Address - City:FARMINGDALE
Practice Address - State:NY
Practice Address - Zip Code:11735-4929
Practice Address - Country:US
Practice Address - Phone:631-834-9380
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-29
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Multi-Specialty