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NPI Code Detail

MEDICARE: UNIVERSAL DIAGNOSTIC LABORATORIES, INC.

MEDICARE: UNIVERSAL DIAGNOSTIC LABORATORIES, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1291U00000XClinical Medical LaboratoryNY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1255332714
Entity Type Code : Organization
Provider Name (Legal Business Name) : UNIVERSAL DIAGNOSTIC LABORATORIES, INC.
Provider Business Mailing Address
First Line : 1414 NEWKIRK AVE
Second Line :
City : BROOKLYN
State : NY
Zip : 11226-6522
Country : US
Telephone Number : 718-859-4777
Fax Number : 718-859-4578
Provider Business Practice Location Address
First Line : 1414 NEWKIRK AVE
Second Line :
City : BROOKLYN
State : NY
Zip : 11226-6522
Country : US
Telephone Number : 718-859-4777
Fax Number : 718-859-4578
Authorized Official
Title or Position : CEO
Name : MR. CRAIG DAWSON
Credential :
Telephone Number : 718-859-4777
Provider Enumeration Date : 08/09/2005
Last Update Date : 08/22/2020

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