Provider Demographics
NPI:1336763531
Name:MEDLIFE DIAGNOSTIC LABORATORIES
Entity type:Organization
Organization Name:MEDLIFE DIAGNOSTIC LABORATORIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MIHAI
Authorized Official - Middle Name:CIPRIAN
Authorized Official - Last Name:TOADER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-508-2010
Mailing Address - Street 1:1717 BRUNSWICK PIKE
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE TWP
Mailing Address - State:NJ
Mailing Address - Zip Code:08648
Mailing Address - Country:US
Mailing Address - Phone:609-508-2010
Mailing Address - Fax:
Practice Address - Street 1:1717 BRUNSWICK AVE
Practice Address - Street 2:
Practice Address - City:LAWRENCE TWP
Practice Address - State:NJ
Practice Address - Zip Code:08648
Practice Address - Country:US
Practice Address - Phone:866-933-0852
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-03
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory