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Organization
MEDICAL DIAGNOSTIC ASSOCIATES, PA
Active
Organization
MEDICAL DIAGNOSTIC ASSOCIATES, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TERRY DYER CMPE (PRACTICE ADMINISTRATOR)
(732) 382-0091
Entity
Organization
Contact information
Practice address
99 BEAUVOIR AVE, SUMMIT, NJ 07901-3533
(908) 608-1504
(908) 608-0078
Mailing address
77 BRANT AVE, SUITE 200, CLARK, NJ 07066-1560
(732) 382-0091
(732) 382-0402
Taxonomy
Speciality
Code
Description
License number
State
332900000X
Non-Pharmacy Dispensing Site
Primary
25MA06949800
NJ
Other
Enumeration date
06/08/2012
Last updated
06/12/2012
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