Provider Demographics
NPI:1558702266
Name:NJ DIAGNOSTIC TESTING LLC
Entity Type:Organization
Organization Name:NJ DIAGNOSTIC TESTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MBR
Authorized Official - Prefix:
Authorized Official - First Name:GAMMAL
Authorized Official - Middle Name:
Authorized Official - Last Name:HASSANIEN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:973-523-4000
Mailing Address - Street 1:606 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07514-1916
Mailing Address - Country:US
Mailing Address - Phone:973-523-4000
Mailing Address - Fax:
Practice Address - Street 1:606 BROADWAY
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07514-1916
Practice Address - Country:US
Practice Address - Phone:973-523-4000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-10
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2085R0202X174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP00423400OtherRAIL ROAD MEDICARE
NJ048963Medicare PIN
NJ117352PWSMedicare PIN