Provider Demographics
NPI:1508506361
Name:MODERN MOLECULAR DIAGNOSTICS CORP
Entity Type:Organization
Organization Name:MODERN MOLECULAR DIAGNOSTICS CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AHMED
Authorized Official - Middle Name:
Authorized Official - Last Name:MOHAMED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-794-8511
Mailing Address - Street 1:430 US HIGHWAY 46
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07004-1977
Mailing Address - Country:US
Mailing Address - Phone:973-794-8511
Mailing Address - Fax:
Practice Address - Street 1:430 US HIGHWAY 46
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07004-1977
Practice Address - Country:US
Practice Address - Phone:973-794-8511
Practice Address - Fax:862-284-3162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-30
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes291U00000XLaboratoriesClinical Medical LaboratoryGroup - Single Specialty