Provider Demographics
NPI:1184079824
Name:LIFESCAN DIAGNOSTICS PC
Entity type:Organization
Organization Name:LIFESCAN DIAGNOSTICS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGEMENT
Authorized Official - Prefix:
Authorized Official - First Name:ENIDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BERBERI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-997-5233
Mailing Address - Street 1:399 MIDLAND AVE
Mailing Address - Street 2:
Mailing Address - City:GARFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07026-1614
Mailing Address - Country:US
Mailing Address - Phone:973-878-3282
Mailing Address - Fax:973-878-1773
Practice Address - Street 1:399 MIDLAND AVE
Practice Address - Street 2:
Practice Address - City:GARFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07026-1614
Practice Address - Country:US
Practice Address - Phone:973-878-3282
Practice Address - Fax:973-878-1773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-02
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2085R0202X, 207RC0000X, 261QM2500X, 261QR0200X
NJ261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiologyGroup - Multi-Specialty
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1184079824OtherNPI
NJ0512044Medicaid
NJ25MA07582500OtherSTATE LICENSE