Provider Demographics
NPI:1912144411
Name:MEDICAL DIVERSIFIED SERVICES, INC.
Entity Type:Organization
Organization Name:MEDICAL DIVERSIFIED SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELLY- ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:MURRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-787-0468
Mailing Address - Street 1:PO BOX 442
Mailing Address - Street 2:
Mailing Address - City:PORT MONMOUTH
Mailing Address - State:NJ
Mailing Address - Zip Code:07758-0442
Mailing Address - Country:US
Mailing Address - Phone:732-787-4068
Mailing Address - Fax:732-787-0632
Practice Address - Street 1:196 HIGHWAY 36 E
Practice Address - Street 2:
Practice Address - City:NORTH MIDDLETOWN
Practice Address - State:NJ
Practice Address - Zip Code:07748-5258
Practice Address - Country:US
Practice Address - Phone:732-787-4068
Practice Address - Fax:732-787-6032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-21
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier