Provider Demographics
NPI:1134100951
Name:ADVANTAGE DIAGNOSTICS TESTING PC
Entity Type:Organization
Organization Name:ADVANTAGE DIAGNOSTICS TESTING PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:STUART
Authorized Official - Middle Name:
Authorized Official - Last Name:DUBOWITCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-424-2000
Mailing Address - Street 1:1001 BRIGGS RD
Mailing Address - Street 2:STE 270
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-4100
Mailing Address - Country:US
Mailing Address - Phone:856-840-0700
Mailing Address - Fax:856-840-0767
Practice Address - Street 1:1001 BRIGGS RD
Practice Address - Street 2:STE 270
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-4100
Practice Address - Country:US
Practice Address - Phone:856-840-0700
Practice Address - Fax:856-840-0767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-09
Last Update Date:2009-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225B00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPulmonary Function TechnologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ077425Medicare ID - Type Unspecified