MEDICARE: PAD DIAGNOSTICS LLC

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
1	246X00000X	Cardiovascular Specialist/Technologist

General Provider Information

NPI Number	:	1356776553
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PAD DIAGNOSTICS LLC

Provider Business Mailing Address
First Line	:	711 HARRISON AVE
Second Line	:
City	:	MAGNOLIA
State	:	NJ
Zip	:	08049-1516
Country	:	US
Telephone Number	:	856-469-5867
Fax Number	:

Provider Business Practice Location Address
First Line	:	711 HARRISON AVE
Second Line	:
City	:	MAGNOLIA
State	:	NJ
Zip	:	08049-1516
Country	:	US
Telephone Number	:	856-469-5867
Fax Number	:

Authorized Official
Title or Position	:	TERRITORY MANAGER
Name	:	MR. HARRISON WEBB
Credential	:
Telephone Number	:	609-923-0157

Provider Enumeration Date	:	09/06/2013
Last Update Date	:	09/06/2013

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Directions to “PAD DIAGNOSTICS LLC ” Practice Location

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