Provider Demographics
NPI:1255996484
Name:MODERN MEDICAL DIAGNOSTIC TESTS PLLC
Entity type:Organization
Organization Name:MODERN MEDICAL DIAGNOSTIC TESTS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:MARCHANY-BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-988-8026
Mailing Address - Street 1:400 W MAIN ST STE 350
Mailing Address - Street 2:
Mailing Address - City:BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11702-3025
Mailing Address - Country:US
Mailing Address - Phone:631-517-9170
Mailing Address - Fax:
Practice Address - Street 1:400 W MAIN ST STE 350
Practice Address - Street 2:
Practice Address - City:BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11702-3025
Practice Address - Country:US
Practice Address - Phone:631-517-9170
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-02
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty