Provider Demographics
NPI:1699238097
Name:REGIONAL ELECTRODIAGNOSTICS LLC
Entity type:Organization
Organization Name:REGIONAL ELECTRODIAGNOSTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:M
Authorized Official - Last Name:KOSMORSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:267-966-5812
Mailing Address - Street 1:303 FLORAL VALE BLVD
Mailing Address - Street 2:
Mailing Address - City:YARDLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19067-5525
Mailing Address - Country:US
Mailing Address - Phone:267-966-5812
Mailing Address - Fax:215-860-7933
Practice Address - Street 1:2141 US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08648-4407
Practice Address - Country:US
Practice Address - Phone:267-966-5812
Practice Address - Fax:215-860-7966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-11
Last Update Date:2019-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty