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General NPI Number Information
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NPI Number | 1730292822
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Entity Type | Organization
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Legal Business Name | MOLECULAR DIAGNOSTIC LABORATORY LLC
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Dates
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Enumeration Date | 08/16/2006
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Last Update Date | 09/02/2025
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Provider Practice Location Address
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Address Line | 950 YALE AVE STE 39
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City | WALLINGFORD
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State | CT
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Zip | 06492-1884
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Country | US
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Telephone | 310-525-5520
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Fax | 310-873-6780
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Provider Business Mailing Address
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Address Line | 950 YALE AVE STE 39
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City | WALLINGFORD
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State | CT
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Zip | 06492-1884
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Country | US
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Telephone | 310-873-6380
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Fax | 310-873-6780
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Authorized Official
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Title or Position | DIRECTOR
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Name | BEN LEV
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Credential |
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Telephone | 310-873-6380
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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 | CL0632
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License Number State | CT
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