Provider Demographics
NPI:1790023547
Name:ADVANCED MOLECULAR DIAGNOSTICS, LLC
Entity type:Organization
Organization Name:ADVANCED MOLECULAR DIAGNOSTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PABLO
Authorized Official - Middle Name:J
Authorized Official - Last Name:UMANSKY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:201-825-0186
Mailing Address - Street 1:136 SUMMIT AVENUE
Mailing Address - Street 2:
Mailing Address - City:MONTVALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07645-1223
Mailing Address - Country:US
Mailing Address - Phone:201-825-0186
Mailing Address - Fax:201-825-0191
Practice Address - Street 1:136 SUMMIT AVENUE
Practice Address - Street 2:
Practice Address - City:MONTVALE
Practice Address - State:NJ
Practice Address - Zip Code:07645-1223
Practice Address - Country:US
Practice Address - Phone:201-825-0186
Practice Address - Fax:201-825-0191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-29
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ0006626291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0366781Medicaid
NJ366781Medicaid