Provider Demographics
NPI:1770137754
Name:RIVER TOWN DIAGNOSTICS LLC
Entity type:Organization
Organization Name:RIVER TOWN DIAGNOSTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ROIZIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:929-650-6052
Mailing Address - Street 1:8563 ARGYLE BUSINESS LOOP STE 2
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32244-6613
Mailing Address - Country:US
Mailing Address - Phone:929-650-6052
Mailing Address - Fax:904-833-3362
Practice Address - Street 1:8563 ARGYLE BUSINESS LOOP STE 2
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32244-6613
Practice Address - Country:US
Practice Address - Phone:929-650-6052
Practice Address - Fax:904-833-3362
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-29
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL10D2173247OtherCLIA
FL29790OtherCOLA ACCREDITATION