Provider Demographics
NPI:1841951878
Name:NELLA DIAGNOSTICS
Entity type:Organization
Organization Name:NELLA DIAGNOSTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/ BILLER
Authorized Official - Prefix:
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:
Authorized Official - Last Name:NASSAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-650-0575
Mailing Address - Street 1:5318 W DEVON AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60646-4108
Mailing Address - Country:US
Mailing Address - Phone:773-774-6440
Mailing Address - Fax:773-774-6405
Practice Address - Street 1:1925 E 95TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60617-4710
Practice Address - Country:US
Practice Address - Phone:773-774-6440
Practice Address - Fax:773-774-6405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-03
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)