Provider Demographics
NPI:1922274091
Name:ADVANCED DIAGNOSTIC TESTING, PC
Entity Type:Organization
Organization Name:ADVANCED DIAGNOSTIC TESTING, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENDON
Authorized Official - Middle Name:A
Authorized Official - Last Name:BEATRICE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:908-252-9900
Mailing Address - Street 1:575 ROUTE 28
Mailing Address - Street 2:STE 207
Mailing Address - City:RARITAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08869-1354
Mailing Address - Country:US
Mailing Address - Phone:908-252-9900
Mailing Address - Fax:908-252-9901
Practice Address - Street 1:575 ROUTE 28
Practice Address - Street 2:STE 207
Practice Address - City:RARITAN
Practice Address - State:NJ
Practice Address - Zip Code:08869-1354
Practice Address - Country:US
Practice Address - Phone:908-252-9900
Practice Address - Fax:908-252-9901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-07
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00530500111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U77214Medicare UPIN