=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932218021
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MRT LABORATORIES INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/30/2006
-----------------------------------------------------
Last Update Date | 01/05/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 50 JOHNSON AVE
-----------------------------------------------------
City | HACKENSACK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07601-4845
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-342-5400
-----------------------------------------------------
Fax | 201-342-1123
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 50 JOHNSON AVE
-----------------------------------------------------
City | HACKENSACK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07601-4845
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-342-5400
-----------------------------------------------------
Fax | 201-342-1123
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | BARBARA G CORDES
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 201-342-5400
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number | 00005854
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------