MEDICARE: GALAXY MOBILE DIAGNOSTICS SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	293D00000X	Physiological Laboratory

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033505532
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GALAXY MOBILE DIAGNOSTICS SERVICES LLC

Provider Business Mailing Address
First Line	:	2 KENNEDY BLVD
Second Line	:	2ND FLOOR
City	:	EAST BRUNSWICK
State	:	NJ
Zip	:	08816-1248
Country	:	US
Telephone Number	:	201-426-0220
Fax Number	:	732-839-9012

Provider Business Practice Location Address
First Line	:	2 KENNEDY BLVD
Second Line	:	2ND FLOOR
City	:	EAST BRUNSWICK
State	:	NJ
Zip	:	08816-1248
Country	:	US
Telephone Number	:	201-426-0220
Fax Number	:	732-839-9012

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. PETER GUDAITIS
Credential	:
Telephone Number	:	718-789-1818

Provider Enumeration Date	:	04/10/2015
Last Update Date	:	11/09/2021

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