MEDICARE: ADVANCED MOLECULAR 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	291U00000X	Clinical Medical Laboratory	0006626	NJ

Other Identifiers

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

General Provider Information

NPI Number	:	1790023547
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED MOLECULAR DIAGNOSTICS, LLC

Provider Business Mailing Address
First Line	:	136 SUMMIT AVENUE
Second Line	:	EAST WING
City	:	MONTVALE
State	:	NJ
Zip	:	07645-1223
Country	:	US
Telephone Number	:	201-825-0186
Fax Number	:	201-825-0191

Provider Business Practice Location Address
First Line	:	136 SUMMIT AVENUE
Second Line	:	EAST WING
City	:	MONTVALE
State	:	NJ
Zip	:	07645-1223
Country	:	US
Telephone Number	:	201-825-0186
Fax Number	:	201-825-0191

Authorized Official
Title or Position	:	CEO
Name	:	PABLO J UMANSKY
Credential	:	PHD
Telephone Number	:	201-825-0186

Provider Enumeration Date	:	01/29/2013
Last Update Date	:	12/30/2025

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