NPIMap

Organization Active NPI

Med Wellness Diagnostic LLC

  • Clinic/Center
  • Albany, NY
National Provider Identifier
1245920099
Registry record updated May 15, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
MED WELLNESS DIAGNOSTIC LLC
Practice address
54 State St Ste 804
Albany, NY 12207-2524
Phone
(833) 294-6969
NPI assigned
May 15, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 15, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Latisha MyrieNPI 1679225502
Title
Ceo
Phone
(833) 294-6969

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary
Clinical Medical Laboratory 291U00000X

Addresses

Primary practice location

54 State St Ste 804
Albany, NY 12207-2524

Mailing address

54 State St Ste 804
Albany, NY 12207-2524
Phone (833) 294-6969

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1684108800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1684108800000",
    "number": "1245920099",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "54 STATE ST STE 804",
            "city": "ALBANY",
            "state": "NY",
            "postal_code": "122072524",
            "telephone_number": "833-294-6969"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "54 STATE ST STE 804",
            "city": "ALBANY",
            "state": "NY",
            "postal_code": "122072524",
            "telephone_number": "833-294-6969"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MED WELLNESS DIAGNOSTIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-05-15",
        "last_updated": "2023-05-15",
        "certification_date": "2023-05-12",
        "status": "A",
        "authorized_official_last_name": "MYRIE",
        "authorized_official_first_name": "LATISHA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "833-294-6969"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Albany, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.