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General NPI Number Information
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NPI Number | 1689588295
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Entity Type | Organization
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Legal Business Name | MEDPATH DIAGNOSTICS INC
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Dates
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Enumeration Date | 09/30/2026
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Last Update Date | 09/30/2026
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Provider Practice Location Address
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Address Line | 1735 N OCEAN AVE STE A
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City | MEDFORD
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State | NY
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Zip | 11763-2671
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Country | US
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Telephone | 631-730-6400
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Fax | 631-730-6410
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Provider Business Mailing Address
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Address Line | 1735 N OCEAN AVE STE A
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City | MEDFORD
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State | NY
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Zip | 11763-2671
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Country | US
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Telephone | 631-730-6400
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Fax | 631-730-6410
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. IMRANA ALI
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Credential | MD
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Telephone | 518-951-6120
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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 | NULL
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