Provider Demographics
NPI:1164701561
Name:FUSION DIAGNOSTICS LABORATORIES
Entity Type:Organization
Organization Name:FUSION DIAGNOSTICS LABORATORIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MONTASER
Authorized Official - Middle Name:
Authorized Official - Last Name:HASSAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-962-0819
Mailing Address - Street 1:210 MALAPARDIS RD
Mailing Address - Street 2:SUITE #103
Mailing Address - City:CEDAR KNOLLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07927-1121
Mailing Address - Country:US
Mailing Address - Phone:973-998-8189
Mailing Address - Fax:973-998-8192
Practice Address - Street 1:210 MALAPARDIS RD
Practice Address - Street 2:SUITE #103
Practice Address - City:CEDAR KNOLLS
Practice Address - State:NJ
Practice Address - Zip Code:07927-1121
Practice Address - Country:US
Practice Address - Phone:973-998-8189
Practice Address - Fax:973-998-8192
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-16
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
291U00000X
NJ0005709291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0355674Medicaid
NJ230683Medicare PIN