Organization
MODERN DIAGNOSTIC LABORATORY, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ARON TESSLER (TREASURER)
(718) 837-5222
Entity
Organization
Contact information
Practice address
1412 BAY RIDGE AVE, BROOKLYN, NY 11219-6231
(718) 837-5222
(718) 259-0088
Mailing address
1412 BAY RIDGE AVE, BROOKLYN, NY 11219-6231
(718) 837-5222
(718) 259-0088
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
PFI: 3848
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01064002
—
NY
05
—
0823708
—
NJ
01
—
L062010
EMPIRE BC/BS
NY
Enumeration date
06/27/2005
Last updated
04/20/2008
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