Provider Demographics
NPI:1801564570
Name:EXPRESS DIAGNOSTICS, LLC
Entity type:Organization
Organization Name:EXPRESS DIAGNOSTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:YAO
Authorized Official - Middle Name:
Authorized Official - Last Name:AGBOLOSU
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:860-833-6928
Mailing Address - Street 1:51 PINECREST DR
Mailing Address - Street 2:
Mailing Address - City:EAST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06118-2737
Mailing Address - Country:US
Mailing Address - Phone:860-833-6928
Mailing Address - Fax:
Practice Address - Street 1:51 PINECREST DR
Practice Address - Street 2:
Practice Address - City:EAST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06118-2737
Practice Address - Country:US
Practice Address - Phone:860-833-6928
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-30
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory