Provider Demographics
NPI:1114524071
Name:MEADOWLANDS DIAGNOSTICS LLC
Entity Type:Organization
Organization Name:MEADOWLANDS DIAGNOSTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:REGINALD
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMUELS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-868-4750
Mailing Address - Street 1:1 KNUTSEN DR
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-2161
Mailing Address - Country:US
Mailing Address - Phone:973-868-4750
Mailing Address - Fax:
Practice Address - Street 1:177 VALLEY BLVD FL 2
Practice Address - Street 2:
Practice Address - City:WOOD RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07075-2011
Practice Address - Country:US
Practice Address - Phone:201-347-6779
Practice Address - Fax:201-347-6788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-05
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory