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General NPI Number Information
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NPI Number | 1013205558
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Entity Type | Organization
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Legal Business Name | NORTHERN NEW ENGLAND DIAGNOSTICS
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Dates
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Enumeration Date | 07/19/2011
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Last Update Date | 07/19/2011
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Provider Practice Location Address
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Address Line | 1053 WESTERN AVE
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City | MANCHESTER
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State | ME
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Zip | 04351-3403
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Country | US
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Telephone | 207-622-4500
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Fax | 207-622-5452
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Provider Business Mailing Address
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Address Line | 1053 WESTERN AVE
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City | MANCHESTER
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State | ME
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Zip | 04351-3403
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Country | US
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Telephone | 207-622-4500
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Fax | 207-622-5452
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | MADELINE MRAZIK
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Credential |
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Telephone | 207-446-4749
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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