Healthcare Provider Details

I. General information

NPI: 1689588295
Provider Name (Legal Business Name): MEDPATH DIAGNOSTICS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1735 N OCEAN AVE STE A
MEDFORD NY
11763-2671
US

IV. Provider business mailing address

1735 N OCEAN AVE STE A
MEDFORD NY
11763-2671
US

V. Phone/Fax

Practice location:
  • Phone: 631-730-6400
  • Fax: 631-730-6410
Mailing address:
  • Phone: 631-730-6400
  • Fax: 631-730-6410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. IMRANA ALI
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 518-951-6120