Provider Demographics
NPI:1407994874
Name:AMERICAN DIAGNOSTIC LABORATORIES INC.
Entity Type:Organization
Organization Name:AMERICAN DIAGNOSTIC LABORATORIES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROMOLO
Authorized Official - Middle Name:
Authorized Official - Last Name:MAURIZI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-206-9505
Mailing Address - Street 1:1185 MORRIS AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-3334
Mailing Address - Country:US
Mailing Address - Phone:908-206-9505
Mailing Address - Fax:908-206-9506
Practice Address - Street 1:1185 MORRIS AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-3334
Practice Address - Country:US
Practice Address - Phone:908-206-9505
Practice Address - Fax:908-206-9506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2009-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA044063261QR0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ403629Medicare ID - Type Unspecified
NJ034525Medicare UPIN