Provider Demographics
NPI:1659088185
Name:MEDICAL DIAGNOSTIC LABORATORIES,LLC
Entity Type:Organization
Organization Name:MEDICAL DIAGNOSTIC LABORATORIES,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REVENUE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MILISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:EARNEST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-528-6613
Mailing Address - Street 1:2439 KUSER RD
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08690-3303
Mailing Address - Country:US
Mailing Address - Phone:609-269-0090
Mailing Address - Fax:609-570-1050
Practice Address - Street 1:8238 S MADISON ST
Practice Address - Street 2:
Practice Address - City:BURR RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60527-5811
Practice Address - Country:US
Practice Address - Phone:630-560-0536
Practice Address - Fax:630-560-0120
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEDICAL DIAGNOSTIC LABORATORIES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-11-03
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory