Medicon Diagnostic Laboratory LLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

MEDICON DIAGNOSTIC LABORATORY LLC

Practice address

1040 Main St
Paterson, NJ 07503-2212

Phone

(973) 832-3405

NPI assigned

Apr 26, 2022

Organization subpart

No

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

Authorized official

Name

Rawan Saleh

Title

Lab Manager

Phone

(973) 832-3405

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Locations

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

{
    "created_epoch": "1650931200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1653523200000",
    "number": "1245974153",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1040 MAIN ST",
            "city": "PATERSON",
            "state": "NJ",
            "postal_code": "075032212",
            "telephone_number": "973-832-3405"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1040 MAIN ST",
            "city": "PATERSON",
            "state": "NJ",
            "postal_code": "075032212",
            "telephone_number": "973-832-3405"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICON DIAGNOSTIC LABORATORY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-04-26",
        "last_updated": "2022-05-26",
        "certification_date": "2022-05-26",
        "status": "A",
        "authorized_official_last_name": "SALEH",
        "authorized_official_first_name": "RAWAN",
        "authorized_official_title_or_position": "LAB MANAGER",
        "authorized_official_telephone_number": "973-832-3405"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIS",
            "identifier": "19317",
            "state": "NJ"
        }
    ],
    "endpoints": [
        {
            "endpointType": "REST",
            "endpointTypeDescription": "RESTful URL",
            "endpoint": "Kolims",
            "affiliation": "N",
            "endpointDescription": "Laboratory Information System",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1040 Main St",
            "city": "Paterson",
            "state": "NJ",
            "country_code": "US",
            "postal_code": "075032212",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Tomicka S McMillion, RN, BSN, MSN, DNP
• Myesha McNeil
• MD Health Group LLC
• Medical Concepts LLC
• Medical Surgical Family Practice of Paterson
• Medicsurg
• Medina Pharmacy Inc
• Medina Pharmacy Inc
• Kathleen Meehan-Hart, MSN, CNM, WHNP-BC
• Randal S Meglio, RPH

• All providers in Paterson, NJ
• Clinical Medical Laboratory in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2022; 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.