Organization
CORAL DIAGNOSTICS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MANJUSHREE MATADIAL DO (MD)
(917) 257-7227
Entity
Organization
Contact information
Practice address
684 MARKET ST, PATERSON, NJ 07513-1231
(917) 257-7227
(973) 807-1613
Mailing address
PO BOX 3042, CLIFTON, NJ 07012-0342
(973) 779-7354
(973) 779-7385
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
25MB07597800
NJ
207R00000X
Internal Medicine Physician
25MB07597800
NJ
261QR0208X
Mobile Radiology Clinic/Center
Primary
25MB07597800
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0044377
—
NJ
01
—
25MB07597800
STATE LICENSE
NJ
Enumeration date
03/26/2009
Last updated
05/27/2009
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