Provider Demographics
NPI:1740593649
Name:MOBILE DIAGNOSTIC TESTING OF PA INC
Entity Type:Organization
Organization Name:MOBILE DIAGNOSTIC TESTING OF PA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:ALKA
Authorized Official - Middle Name:V
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-866-0355
Mailing Address - Street 1:1115 OCEAN PKWY
Mailing Address - Street 2:LEVEL C
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-4073
Mailing Address - Country:US
Mailing Address - Phone:718-338-6300
Mailing Address - Fax:
Practice Address - Street 1:920 MADISON AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:AUDUBON
Practice Address - State:PA
Practice Address - Zip Code:19403-2307
Practice Address - Country:US
Practice Address - Phone:973-866-0355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-20
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty