Prostate Diagnostics, LLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

03D1098706 Issued in AZ

Legal business name

PROSTATE DIAGNOSTICS, LLC

Practice address

16601 N 40TH St
Suite 222
Phoenix, AZ 85032-3345

Phone

(602) 368-8001

Fax

(602) 368-1386

NPI assigned

Apr 19, 2009

Last updated

Mar 19, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Boaz Lerer

Title

Managing Member

Phone

(602) 368-8001

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1240099200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1426723200000",
    "number": "1699918763",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4245 E DANBURY RD",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850329204",
            "telephone_number": "602-788-7814"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16601 N 40TH ST",
            "address_2": "SUITE 222",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850323345",
            "telephone_number": "602-368-8001",
            "fax_number": "602-368-1386"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROSTATE DIAGNOSTICS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-04-19",
        "last_updated": "2015-03-19",
        "status": "A",
        "authorized_official_last_name": "LERER",
        "authorized_official_first_name": "BOAZ",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "602-368-8001",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "AZ",
            "license": "03D1098706",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Medical Laboratory in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Clinical Medical Laboratory in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.