1750373908 NPI number — MEDICAL DIAGNOSTIC LABORATORIES,LLC

Table of content: (NPI 1750373908)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750373908 NPI number — MEDICAL DIAGNOSTIC LABORATORIES,LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEDICAL DIAGNOSTIC LABORATORIES,LLC
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:
Provider Other Organization Name Type Code:
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:
1750373908
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/29/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2439 KUSER RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAMILTON
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08690-3303
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
877-269-0090
Provider Business Mailing Address Fax Number:
609-570-1050

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2439 KUSER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAMILTON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08690-3303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
877-269-0090
Provider Business Practice Location Address Fax Number:
609-570-1050
Provider Enumeration Date:
08/15/2005

Additional Information

Authorized Official

Authorized Official Last Name:
MORDECHAI
Authorized Official First Name:
ELI
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
877-269-0090

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  0000875 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000100331 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0421260 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 806585600 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: L00157 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 030726200 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 044982200 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100504421 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1014034040001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 121654600 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200297200A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2396045 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7001238 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7512406 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 036782400 , issued by the state of ( DC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1000024322 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100250923-00 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 147734101 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1750373908 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009995390 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1130877 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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