Provider Demographics
NPI:1811398639
Name:AMERICAN DIAGNOSTIC LAB., INC.
Entity Type:Organization
Organization Name:AMERICAN DIAGNOSTIC LAB., INC.
Other - Org Name:AMERICAN OTHOTIC & BRACE CO.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GOPE
Authorized Official - Middle Name:
Authorized Official - Last Name:GIDWANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-984-5200
Mailing Address - Street 1:92 GRAPE ST # 2A
Mailing Address - Street 2:
Mailing Address - City:NEW BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02740-2143
Mailing Address - Country:US
Mailing Address - Phone:508-984-5200
Mailing Address - Fax:508-819-4998
Practice Address - Street 1:92 GRAPE ST # 2A
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02740-2143
Practice Address - Country:US
Practice Address - Phone:508-984-5200
Practice Address - Fax:508-819-4998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-11
Last Update Date:2014-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MANOT REQUIRED332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies