Healthcare Provider Details

I. General information

NPI: 1992188874
Provider Name (Legal Business Name): MDR DIAGNOSTICS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2015
Last Update Date: 07/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 GEORGE ST SUITE 415
NEW BRUNSWICK NJ
08901-2008
US

IV. Provider business mailing address

317 GEORGE ST SUITE 415
NEW BRUNSWICK NJ
08901-2008
US

V. Phone/Fax

Practice location:
  • Phone: 856-816-5628
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DAVID KATZ
Title or Position: OPERATIONS MANAGER
Credential:
Phone: 856-816-5628