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NPI Code Detail

MEDICARE: ANALYTICAL DIAGNOSTIC LABS,INC

MEDICARE: ANALYTICAL DIAGNOSTIC LABS,INC
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
1291U00000XClinical Medical Laboratory3804NY

General Provider Information

NPI Number : 1750445284
Entity Type Code : Organization
Provider Name (Legal Business Name) : ANALYTICAL DIAGNOSTIC LABS,INC
Provider Business Mailing Address
First Line : 2115 AVENUE X
Second Line :
City : BROOKLYN
State : NY
Zip : 11235-2910
Country : US
Telephone Number : 718-646-6000
Fax Number : 718-934-5852
Provider Business Practice Location Address
First Line : 2115 AVENUE X
Second Line :
City : BROOKLYN
State : NY
Zip : 11235-2910
Country : US
Telephone Number : 718-646-6000
Fax Number : 718-934-5852
Authorized Official
Title or Position : PRESIDENT
Name : MR. GERSHON SONTAG
Credential :
Telephone Number : 718-646-6000
Provider Enumeration Date : 12/20/2006
Last Update Date : 01/23/2013

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