Organization Active NPI

Superb Diagnostics, LLC

  • Clinical Medical Laboratory
  • Hackensack, NJ
National Provider Identifier
1497423198
Registry record updated Aug 30, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
Legal business name
SUPERB DIAGNOSTICS, LLC
Practice address
810 Main St Ste 2
Hackensack, NJ 07601-4802
Phone
(551) 209-0080
NPI assigned
Aug 30, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 30, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Boris Katava
Title
Owner
Phone
(551) 209-0080

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X Primary

Addresses

Primary practice location

810 Main St Ste 2
Hackensack, NJ 07601-4802

Mailing address

810 Main St Ste 2
Hackensack, NJ 07601-4802
Phone (551) 209-0080

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220110002669 NJ Part B Supplier - Independent Clinical Laboratory 1153713839 Practice locations: Hackensack, NJ

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
31D2243031Superb Diagnostic LLC810 Main Street, Hackensack, NJ 07601AccreditationDec 2, 2027

National Provider Directory

National Provider Directory

Locations

810 Main St
Ste 2
Hackensack, NJ 07601
Phone (551) 209-0080

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1630281600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1630281600000",
    "number": "1497423198",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "810 MAIN ST STE 2",
            "city": "HACKENSACK",
            "state": "NJ",
            "postal_code": "076014802",
            "telephone_number": "551-209-0080"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "810 MAIN ST STE 2",
            "city": "HACKENSACK",
            "state": "NJ",
            "postal_code": "076014802",
            "telephone_number": "551-209-0080"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUPERB DIAGNOSTICS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-30",
        "last_updated": "2021-08-30",
        "certification_date": "2021-08-30",
        "status": "A",
        "authorized_official_last_name": "KATAVA",
        "authorized_official_first_name": "BORIS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "551-209-0080"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hackensack, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.