Medlife Diagnostic Laboratories
Organization Active NPI Clinical Medical Laboratory · Lawrence TWP, NJ
NPI 1336763531 · NPPES record last updated Aug 3, 2020
Key facts
- NPI
- 1336763531
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Clinical Medical Laboratory 291U00000X
- Legal business name
- MEDLIFE DIAGNOSTIC LABORATORIES
- Practice address
- 1717 Brunswick Ave
Lawrence TWP, NJ 08648 - Phone
- (866) 933-0852
- NPI assigned
- Jun 3, 2020
- Organization subpart
- No
Authorized official
- Name
- Mihai Ciprian Toader
- Title
- President
- Phone
- (609) 508-2010
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 31D2183978 | Medlife Diagnostic Laboratories | Accreditation | Jul 27, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NJ
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20200831002729 | NJ | Part B Supplier - Independent Clinical Laboratory | 2365869765 | Practice locations: Lawrence TWP, NJ |
National Provider Directory
Locations
1717 Brunswick Ave
Lawrence Twp, NJ 08648
Phone (866) 933-0852
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Medical Laboratory | 291U00000X | Yes |
Addresses
Primary practice location
1717 Brunswick Ave
Lawrence TWP, NJ 08648
Mailing address
1717 Brunswick Pike
Lawrence TWP, NJ 08648
Phone (609) 508-2010
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 3, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.