Organization
MED WELLNESS DIAGNOSTIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LATISHA MYRIE (CEO)
(833) 294-6969
Entity
Organization
Contact information
Practice address
54 STATE ST STE 804, ALBANY, NY 12207-2524
(833) 294-6969
Mailing address
54 STATE ST STE 804, ALBANY, NY 12207-2524
(833) 294-6969
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
291U00000X
Clinical Medical Laboratory
—
—
Other
Enumeration date
05/15/2023
Last updated
05/15/2023
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