Provider Demographics
NPI:1336407006
Name:GARDEN CITY DIAGNOSTICS
Entity type:Organization
Organization Name:GARDEN CITY DIAGNOSTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ASSOCIATE LABORATORY DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:LYDIA
Authorized Official - Last Name:KIMMEL
Authorized Official - Suffix:
Authorized Official - Credentials:RN, PHD, CHMM
Authorized Official - Phone:313-836-2381
Mailing Address - Street 1:28050 FORD RD STE C
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48135-2967
Mailing Address - Country:US
Mailing Address - Phone:313-836-2381
Mailing Address - Fax:313-762-1718
Practice Address - Street 1:28050 FORD RD STE B
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:MI
Practice Address - Zip Code:48135-2967
Practice Address - Country:US
Practice Address - Phone:734-799-1338
Practice Address - Fax:313-762-1718
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-01
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI23D2035755291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI23D2035755OtherCMS CLIA