Provider Demographics
NPI:1093971251
Name:ADVANCED DIAGNOSTICS LABORATORY, PLLC
Entity Type:Organization
Organization Name:ADVANCED DIAGNOSTICS LABORATORY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NEAL
Authorized Official - Middle Name:S
Authorized Official - Last Name:GOLDSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-486-9008
Mailing Address - Street 1:25241 GRAND RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:REDFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48240-1404
Mailing Address - Country:US
Mailing Address - Phone:313-486-9008
Mailing Address - Fax:
Practice Address - Street 1:25241 GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:REDFORD
Practice Address - State:MI
Practice Address - Zip Code:48240-1404
Practice Address - Country:US
Practice Address - Phone:313-486-9008
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-06
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory