Provider Demographics
NPI:1114723418
Name:MEDTEST MEDICAL & MOBILE GROUP APC
Entity type:Organization
Organization Name:MEDTEST MEDICAL & MOBILE GROUP APC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:COVELLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-241-6666
Mailing Address - Street 1:4780 W MISSION BLVD STE 207
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:CA
Mailing Address - Zip Code:91762-4406
Mailing Address - Country:US
Mailing Address - Phone:914-774-9722
Mailing Address - Fax:
Practice Address - Street 1:4780 W MISSION BLVD STE 207
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:CA
Practice Address - Zip Code:91762-4406
Practice Address - Country:US
Practice Address - Phone:914-774-9722
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-19
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty