1285760041 NPI number — MOBILE DIAGNOSTIC TESTING SERVICES, INC

Table of content: (NPI 1285760041)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285760041 NPI number — MOBILE DIAGNOSTIC TESTING SERVICES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MOBILE DIAGNOSTIC TESTING SERVICES, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
HEALTHTRAC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1285760041
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/17/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4950 GENESEE ST
Provider Second Line Business Mailing Address:
SUITE 180
Provider Business Mailing Address City Name:
BUFFALO
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14225-5550
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-686-7100
Provider Business Mailing Address Fax Number:
716-614-3282

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
269 SHEFFIELD ST
Provider Second Line Business Practice Location Address:
SUITE 5C
Provider Business Practice Location Address City Name:
MOUNTAINSIDE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07092-2318
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
908-518-0150
Provider Business Practice Location Address Fax Number:
718-886-5762
Provider Enumeration Date:
02/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ROBINSON
Authorized Official First Name:
ALAN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
716-614-3285

Provider Taxonomy Codes

  • Taxonomy code: 2085U0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 630000708 . This is a "RAILROAD" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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