MEDICAL DIAGNOSTIC LABORATORIES,LLC

Provider Demographics

• NPI: 1750373908
• Name: MEDICAL DIAGNOSTIC LABORATORIES,LLC
• Entity type: Organization
• Organization Name: MEDICAL DIAGNOSTIC LABORATORIES,LLC
• Authorized Official - Title/Position: CHIEF EXECUTIVE OFFICER
• Authorized Official - Prefix: DR
• Authorized Official - First Name: ELI
• Authorized Official - Last Name: MORDECHAI
• Authorized Official - Credentials: PHD
• Authorized Official - Phone: 877-269-0090
• Mailing Address - Street 1: 2439 KUSER RD
• Mailing Address - City: HAMILTON
• Mailing Address - State: NJ
• Mailing Address - Zip Code: 08690-3303
• Mailing Address - Country: US
• Mailing Address - Phone: 877-269-0090
• Mailing Address - Fax: 609-570-1050
• Practice Address - Street 1: 2439 KUSER RD
• Practice Address - City: HAMILTON
• Practice Address - State: NJ
• Practice Address - Zip Code: 08690-3303
• Practice Address - Country: US
• Practice Address - Phone: 877-269-0090
• Practice Address - Fax: 609-570-1050
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2005-08-15
• Last Update Date: 2022-08-29

Provider Licenses

State	License ID	Taxonomies
NJ	0000875	291U00000X

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization
Yes	291U00000X	Laboratories	Clinical Medical Laboratory

Provider Identifiers

State	Identifier ID	ID Type	Issuer
VA	000100331	Medicaid
MT	0421260	Medicaid
ID	806585600	Medicaid
SC	L00157	Medicaid
FL	030726200	Medicaid
MN	044982200	Medicaid
NV	100504421	Medicaid
PA	1014034040001	Medicaid
WY	121654600	Medicaid
KS	200297200A	Medicaid
OH	2396045	Medicaid
NC	7001238	Medicaid
NJ	7512406	Medicaid
DC	036782400	Medicaid
DE	1000024322	Medicaid
NE	100250923-00	Medicaid
TX	147734101	Medicaid
CA	1750373908	Medicaid
AL	009995390	Medicaid
LA	1130877	Medicaid
NH	30803540	Medicaid
VT	1010108	Medicaid
MI	164514825	Medicaid
ME	165950000	Medicaid
OR	241804	Medicaid
CO	57875332	Medicaid
WA	7119282	Medicaid
MS	00126252	Medicaid
TN	4490734	Medicaid
GA	539994613A	Medicaid
IA	0569350	Medicaid
IN	200425980A	Medicaid
WV	6703060000	Medicaid
MO	706037900	Medicaid
AR	152606709	Medicaid
AK	1575189	Medicaid
WI	32939800	Medicaid
KY	37000551	Medicaid
MD	401835400	Medicaid
NM	47927763	Medicaid
AZ	775398	Medicaid
IL	XXXXXXXXX	Medicaid
WA	7119282	Medicaid