Provider Demographics
NPI:1992413744
Name:UNIVERSAL DIAGNOSTIC LABORATORY LLC
Entity type:Organization
Organization Name:UNIVERSAL DIAGNOSTIC LABORATORY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDR
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAITSEV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:754-900-5688
Mailing Address - Street 1:PO BOX 1140
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07602-1140
Mailing Address - Country:US
Mailing Address - Phone:754-900-5688
Mailing Address - Fax:754-301-7831
Practice Address - Street 1:2500 HOLLYWOOD BLVD STE 305
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33020-6615
Practice Address - Country:US
Practice Address - Phone:754-900-5688
Practice Address - Fax:754-301-7831
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-10
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory