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General NPI Number Information
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NPI Number | 1144716424
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Entity Type | Organization
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Legal Business Name | ADVANCED DIAGNOSTICS LABORATORY LLC
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Dates
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Enumeration Date | 07/10/2018
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Last Update Date | 01/11/2024
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Provider Practice Location Address
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Address Line | 1030 KINGS HWY N STE 304
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City | CHERRY HILL
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State | NJ
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Zip | 08034-1907
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Country | US
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Telephone | 856-320-2143
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Fax | 856-320-2147
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Provider Business Mailing Address
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Address Line | 950 EAGLES LANDING PKWY # 133
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City | STOCKBRIDGE
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State | GA
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Zip | 30281-7343
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Country | US
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Telephone | 856-320-2143
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Fax | 856-320-2147
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Authorized Official
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Title or Position | COO
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Name | PAMELA R BAYLIN
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Credential |
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Telephone | 770-371-7711
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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 | 0012217
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License Number State | NJ
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