Provider Demographics
NPI:1205063112
Name:QDX PATH ALLIANCE, PC
Entity type:Organization
Organization Name:QDX PATH ALLIANCE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:N
Authorized Official - Last Name:QURESHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD,PHD
Authorized Official - Phone:866-909-7284
Mailing Address - Street 1:46 JACKSON DRIVE
Mailing Address - Street 2:
Mailing Address - City:CRANFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07016-3504
Mailing Address - Country:US
Mailing Address - Phone:866-909-7284
Mailing Address - Fax:908-272-1478
Practice Address - Street 1:70 JACKSON DRIVE UNIT H3
Practice Address - Street 2:
Practice Address - City:CRANFORD
Practice Address - State:NJ
Practice Address - Zip Code:07016-3512
Practice Address - Country:US
Practice Address - Phone:866-909-7284
Practice Address - Fax:908-272-1478
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-18
Last Update Date:2009-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06546400291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory