Organization
COMMONWEALTH DIAGNOSTICS INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GEORGE TKEBUCHAVA (PRESIDENT)
(917) 562-7003
Entity
Organization
Contact information
Practice address
2270 UNIVERSITY AVE, STE 1B, BRONX, NY 10468-6265
(917) 562-7003
(617) 275-0851
Mailing address
1924 OCEAN AVE, APT 2B, BROOKLYN, NY 11230-6719
(917) 562-7003
(617) 275-0851
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
291U00000X
Clinical Medical Laboratory
—
—
Other
Enumeration date
02/03/2016
Last updated
02/03/2016
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