Provider Demographics
NPI:1740237858
Name:MDR DIAGNOSTICS LLC
Entity Type:Organization
Organization Name:MDR DIAGNOSTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:KATZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-853-0305
Mailing Address - Street 1:PO BOX 750
Mailing Address - Street 2:
Mailing Address - City:MOORESTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08057-0750
Mailing Address - Country:US
Mailing Address - Phone:609-396-0021
Mailing Address - Fax:800-717-0334
Practice Address - Street 1:317 GEORGE ST
Practice Address - Street 2:SUITE 415
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-2008
Practice Address - Country:US
Practice Address - Phone:609-396-0021
Practice Address - Fax:800-717-0334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA03323600246X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246X00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ335V00000XOtherTAXONOMY
NJ335V00000XOtherTAXONOMY