Organization
JOLI DIAGNOSTIC INC
Active
Organization
JOLI DIAGNOSTIC INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. AMIN TJOTA MD PHD (LABORATORY DIRECTOR)
(716) 639-0443
Entity
Organization
Contact information
Practice address
2451 WEHRLE DR, WILLIAMSVILLE, NY 14221-7141
(716) 639-0443
(716) 639-0471
Mailing address
2451 WEHRLE DR, WILLIAMSVILLE, NY 14221-7141
(716) 639-0443
(716) 639-0471
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
49181421A170
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
49181421A170
NYS DEPT OF HEALTH
NY
Enumeration date
04/21/2006
Last updated
08/22/2020
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