Organization
AVANTIC MEDICAL LAB
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EDWARD S. LIU (DIRECTOR)
(732) 474-1120
Entity
Organization
Contact information
Practice address
3880 PARK AVE UNIT 100, EDISON, NJ 08820-3012
(732) 474-1120
Mailing address
3880 PARK AVE UNIT 100, EDISON, NJ 08820-3012
(732) 474-1120
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0682543
—
NJ
Enumeration date
05/21/2018
Last updated
08/31/2023
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