# MEDICAL DIAGNOSTIC ASSOCIATES, PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1508128224
- **Authorized official:** TERRY DYER CMPE (PRACTICE ADMINISTRATOR)
- **Authorized official phone:** (732) 382-0091

## Contact information

- **Practice address:** 99 BEAUVOIR AVE, SUMMIT, NJ 07901-3533
- **Practice address phone:** (908) 608-1504
- **Practice address fax:** (908) 608-0078
- **Mailing address:** 77 BRANT AVE, SUITE 200, CLARK, NJ 07066-1560
- **Mailing address phone:** (732) 382-0091
- **Mailing address fax:** (732) 382-0402

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332900000X | Non-Pharmacy Dispensing Site | 25MA06949800 | NJ | Yes |

## Other

- **Enumeration date:** 06/08/2012
- **Last updated:** 06/12/2012