Med Tech Clinical Laboratory,Inc

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

0000855 Issued in NJ

Legal business name

MED TECH CLINICAL LABORATORY,INC

Practice address

175 Cross Keys Rd
Suite 203
Berlin, NJ 08009-9263

Phone

(856) 768-0701

Fax

(856) 768-0702

NPI assigned

Nov 7, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Bijan Yashaya

Title

Manager

Phone

(856) 768-0701

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NJ

Enrollment records 1

Locations

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

{
    "created_epoch": "1162857600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1255400065",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "438 GANTTOWN RD",
            "address_2": "SUITE B-8",
            "city": "SEWELL",
            "state": "NJ",
            "postal_code": "080802341",
            "telephone_number": "856-768-0701",
            "fax_number": "856-768-0702"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "175 CROSS KEYS RD",
            "address_2": "SUITE 203",
            "city": "BERLIN",
            "state": "NJ",
            "postal_code": "080099263",
            "telephone_number": "856-768-0701",
            "fax_number": "856-768-0702"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MED TECH CLINICAL LABORATORY,INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-07",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "YASHAYA",
        "authorized_official_first_name": "BIJAN",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "856-768-0701",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "NJ",
            "license": "0000855",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Richard M Mauriello, DO
• Douglas J. Mayer, MD
• Jenna L McDaniels, MA BCBA
• Courtney McLaughlin, MSW, LSW
• Charles Thomas McSweeney Jr., NRP
• Derrick Medearis
• Rivea Medley
• Tawana M. Medlin, D.D.S
• Katherine Mendez, MA, LAC
• Anita Johanna Menewisch, LAC, NCC

• Clinical Medical Laboratory in Berlin, NJ
• Providers in Berlin, NJ by specialty
• Clinical Medical Laboratory in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.