Provider Demographics
NPI:1013205558
Name:NORTHERN NEW ENGLAND DIAGNOSTICS
Entity Type:Organization
Organization Name:NORTHERN NEW ENGLAND DIAGNOSTICS
Other - Org Name:MANCHESTER DIAGNOSTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MADELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:MRAZIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-446-4749
Mailing Address - Street 1:1053 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:ME
Mailing Address - Zip Code:04351-3403
Mailing Address - Country:US
Mailing Address - Phone:207-622-4500
Mailing Address - Fax:207-622-5452
Practice Address - Street 1:1053 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:ME
Practice Address - Zip Code:04351-3403
Practice Address - Country:US
Practice Address - Phone:207-622-4500
Practice Address - Fax:207-622-5452
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-19
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory