Provider Demographics
NPI:1356734925
Name:MOLECULARDX, LLC
Entity type:Organization
Organization Name:MOLECULARDX, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SIDNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDBLATT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:814-361-6993
Mailing Address - Street 1:620 7TH ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:WINDBER
Mailing Address - State:PA
Mailing Address - Zip Code:15963-1300
Mailing Address - Country:US
Mailing Address - Phone:814-361-6993
Mailing Address - Fax:814-361-6998
Practice Address - Street 1:620 7TH ST
Practice Address - Street 2:SUITE C
Practice Address - City:WINDBER
Practice Address - State:PA
Practice Address - Zip Code:15963-1300
Practice Address - Country:US
Practice Address - Phone:814-361-6993
Practice Address - Fax:814-361-6998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-06
Last Update Date:2015-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA032803291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory