Healthcare Provider Details

I. General information

NPI: 1457537904
Provider Name (Legal Business Name): MEDEX DIAGNOSTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2008
Last Update Date: 01/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 VERMEER DR APT 3
SOUTH AMBOY NJ
08879-2347
US

IV. Provider business mailing address

12 VERMEER DR APT 3
SOUTH AMBOY NJ
08879-2347
US

V. Phone/Fax

Practice location:
  • Phone: 954-478-1170
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335V00000X
TaxonomyPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
License Number
License Number State

VIII. Authorized Official

Name: SVETLANA JOSAN
Title or Position: PRESIDENT
Credential:
Phone: 917-704-3883