Healthcare Provider Details

I. General information

NPI: 1811398639
Provider Name (Legal Business Name): AMERICAN DIAGNOSTIC LAB., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2014
Last Update Date: 09/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

92 GRAPE ST # 2A
NEW BEDFORD MA
02740-2143
US

IV. Provider business mailing address

92 GRAPE ST # 2A
NEW BEDFORD MA
02740-2143
US

V. Phone/Fax

Practice location:
  • Phone: 508-984-5200
  • Fax: 508-819-4998
Mailing address:
  • Phone: 508-984-5200
  • Fax: 508-819-4998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberNOT REQUIRED
License Number StateMA

VIII. Authorized Official

Name: MR. GOPE GIDWANI
Title or Position: PRESIDENT
Credential:
Phone: 508-984-5200