Provider Demographics
NPI:1659454767
Name:ACCUMED DIAGNOSTIC LABORATORY INC
Entity type:Organization
Organization Name:ACCUMED DIAGNOSTIC LABORATORY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:LEVY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-721-3763
Mailing Address - Street 1:540 BORDENTOWN AVENUE
Mailing Address - Street 2:SECOND FLOOR SUITE 4
Mailing Address - City:SOUTH AMBOY
Mailing Address - State:NJ
Mailing Address - Zip Code:08879
Mailing Address - Country:US
Mailing Address - Phone:732-721-3763
Mailing Address - Fax:732-721-7600
Practice Address - Street 1:540 BORDENTOWN AVENUE
Practice Address - Street 2:SECOND FLOOR SUITE 4
Practice Address - City:SOUTH AMBOY
Practice Address - State:NJ
Practice Address - Zip Code:08879
Practice Address - Country:US
Practice Address - Phone:732-721-3763
Practice Address - Fax:732-721-7600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3020801Medicaid
NJ300586Medicare ID - Type Unspecified