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General NPI Number Information
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NPI Number | 1255400065
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Entity Type | Organization
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Legal Business Name | MED TECH CLINICAL LABORATORY,INC
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Dates
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Enumeration Date | 11/07/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 175 CROSS KEYS RD SUITE 203
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City | BERLIN
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State | NJ
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Zip | 08009-9263
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Country | US
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Telephone | 856-768-0701
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Fax | 856-768-0702
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Provider Business Mailing Address
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Address Line | 438 GANTTOWN RD SUITE B-8
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City | SEWELL
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State | NJ
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Zip | 08080-2341
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Country | US
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Telephone | 856-768-0701
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Fax | 856-768-0702
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Authorized Official
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Title or Position | MANAGER
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Name | MR. BIJAN YASHAYA
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Credential |
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Telephone | 856-768-0701
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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 | 0000855
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License Number State | NJ
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