Provider Demographics
NPI:1760719710
Name:MOBILE DIAGNOSTIC TESTING OF NJ LLC
Entity Type:Organization
Organization Name:MOBILE DIAGNOSTIC TESTING OF NJ LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VIJAY
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-866-0355
Mailing Address - Street 1:1279 ROUTE 46
Mailing Address - Street 2:SUITE 4
Mailing Address - City:PARSIPPANY
Mailing Address - State:NJ
Mailing Address - Zip Code:07054-4904
Mailing Address - Country:US
Mailing Address - Phone:973-866-0355
Mailing Address - Fax:
Practice Address - Street 1:1279 ROUTE 46
Practice Address - Street 2:SUITE 4
Practice Address - City:PARSIPPANY
Practice Address - State:NJ
Practice Address - Zip Code:07054-4904
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:2009-11-12
Last Update Date:2010-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty