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General NPI Number Information
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NPI Number | 1265878276
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Entity Type | Organization
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Legal Business Name | UNIVERSAL DIAGNOSTIC LABORATORIES
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Dates
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Enumeration Date | 05/16/2013
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Last Update Date | 05/16/2013
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Provider Practice Location Address
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Address Line | 5907 71ST AVE
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City | RIDGEWOOD
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State | NY
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Zip | 11385-5633
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Country | US
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Telephone | 718-628-9800
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Fax | 718-628-1810
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Provider Business Mailing Address
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Address Line | 5907 71ST AVE
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City | RIDGEWOOD
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State | NY
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Zip | 11385-5633
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Country | US
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Telephone | 718-628-9800
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Fax | 718-628-1810
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. IRFAN S CHAUDHRY
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Credential |
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Telephone | 718-628-9800
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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 | 8739
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License Number State | NY
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