Organization
MEDICAL LABORATORY DIAGNOSTICS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GEORGE N MITITLENES PHD., HCLD (DIRECTOR)
(973) 731-2900
Entity
Organization
Contact information
Practice address
85 HORSEHILL RD, ATTN BILLING DEPT, CEDAR KNOLLS, NJ 07927-2003
(973) 731-2900
(973) 292-9461
Mailing address
85 HORSEHILL RD, ATTN BILLING DEPT, CEDAR KNOLLS, NJ 07927-2003
(973) 731-2900
(973) 292-9461
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
0000878
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2568802
—
NJ
01
—
304514
MEDICARE PTAN #
NJ
01
—
690927005
PALMETTO GBA RAILROAD M/E
NJ
01
—
LAB 521
OXFORD PROVIDER #
NJ
01
—
NJ0947
HEALTHNET PROVIDER #
NJ
Enumeration date
06/13/2005
Last updated
05/17/2016
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