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General NPI Number Information
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NPI Number | 1760693337
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Entity Type | Organization
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Legal Business Name | MEDICAL DIAGNOSTIC GROUP LAB
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Dates
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Enumeration Date | 05/25/2007
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Last Update Date | 05/22/2008
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Provider Practice Location Address
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Address Line | 210 E MAIN ST
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City | MIDDLETOWN
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State | NY
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Zip | 10940-4038
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Country | US
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Telephone | 845-342-5681
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Fax | 845-342-0470
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Provider Business Mailing Address
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Address Line | 210 E MAIN ST
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City | MIDDLETOWN
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State | NY
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Zip | 10940-4038
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Country | US
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Telephone | 845-342-5681
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Fax | 845-342-0470
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Authorized Official
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Title or Position | LAB DIRECTOR
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Name | DR. ELLIOTT T FRIEDMAN
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Credential | M.D.
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Telephone | 845-342-5681
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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 | CLIA33D0653745
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License Number State | NY
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