Healthcare Provider Details

I. General information

NPI: 1184079824
Provider Name (Legal Business Name): LIFESCAN DIAGNOSTICS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2016
Last Update Date: 02/20/2025
Certification Date: 02/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

399 MIDLAND AVE
GARFIELD NJ
07026-1614
US

IV. Provider business mailing address

399 MIDLAND AVE
GARFIELD NJ
07026-1614
US

V. Phone/Fax

Practice location:
  • Phone: 973-878-3282
  • Fax: 973-878-1773
Mailing address:
  • Phone: 973-878-3282
  • Fax: 973-878-1773

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: ENIDA BERBERI
Title or Position: MANAGEMENT
Credential:
Phone: 973-997-5233