NPIMap

Organization Active NPI

Medical Diagnostic Laboratories,LLC

  • Clinical Medical Laboratory
  • Hamilton, NJ
National Provider Identifier
1750373908
Registry record updated Aug 29, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
License
0000875 Issued in NJ
Legal business name
MEDICAL DIAGNOSTIC LABORATORIES,LLC
Practice address
2439 Kuser Rd
Hamilton, NJ 08690-3303
Phone
(877) 269-0090
Fax
(609) 570-1050
NPI assigned
Aug 15, 2005
Last updated
Aug 29, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 29, 2022

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

Authorized official

Name
Dr. Eli Mordechai, PHD
Title
Chief Executive Officer
Phone
(877) 269-0090

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X 0000875 NJ Primary

Addresses

Primary practice location

2439 Kuser Rd
Hamilton, NJ 08690-3303

Mailing address

2439 Kuser Rd
Hamilton, NJ 08690-3303
Phone (877) 269-0090

Other identifiers 42

IdentifierTypeStateIssuer
000100331MedicaidVA
0421260MedicaidMT
806585600MedicaidID
L00157MedicaidSC
030726200MedicaidFL
044982200MedicaidMN
100504421MedicaidNV
1014034040001MedicaidPA
121654600MedicaidWY
200297200AMedicaidKS
2396045MedicaidOH
7001238MedicaidNC
7512406MedicaidNJ
036782400MedicaidDC
1000024322MedicaidDE
100250923-00MedicaidNE
147734101MedicaidTX
1750373908MedicaidCA
009995390MedicaidAL
1130877MedicaidLA
30803540MedicaidNH
1010108MedicaidVT
164514825MedicaidMI
165950000MedicaidME
241804MedicaidOR
57875332MedicaidCO
7119282MedicaidWA
00126252MedicaidMS
4490734MedicaidTN
539994613AMedicaidGA
0569350MedicaidIA
200425980AMedicaidIN
6703060000MedicaidWV
706037900MedicaidMO
152606709MedicaidAR
1575189MedicaidAK
32939800MedicaidWI
37000551MedicaidKY
401835400MedicaidMD
47927763MedicaidNM
775398MedicaidAZ
XXXXXXXXXMedicaidIL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040713001425 NJ Part B Supplier - Independent Clinical Laboratory 8123006277 Practice locations: Hamilton, NJ

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
31D0938156Medical Diagnostic Laboratories LLC2439 Kuser Road, Hamilton, NJ 08690AccreditationMay 21, 2027

National Provider Directory

National Provider Directory
Tax ID family
Medical Diagnostic Laboratoriesllc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

2439 Kuser Rd
Ste C
Hamilton, NJ 08690

133 Gaither Dr
Ste C
Mount Laurel, NJ 08054
Phone (856) 608-1696

2439 Kuser Rd
Trenton, NJ 08690
Phone (877) 269-0090

NPI Registry JSON

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

{
    "created_epoch": "1124064000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1661731200000",
    "number": "1750373908",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2439 KUSER RD",
            "city": "HAMILTON",
            "state": "NJ",
            "postal_code": "086903303",
            "telephone_number": "877-269-0090",
            "fax_number": "609-570-1050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2439 KUSER RD",
            "city": "HAMILTON",
            "state": "NJ",
            "postal_code": "086903303",
            "telephone_number": "877-269-0090",
            "fax_number": "609-570-1050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICAL DIAGNOSTIC LABORATORIES,LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-15",
        "last_updated": "2022-08-29",
        "certification_date": "2022-08-29",
        "status": "A",
        "authorized_official_last_name": "MORDECHAI",
        "authorized_official_first_name": "ELI",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "877-269-0090",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
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            "primary": true
        }
    ],
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    "endpoints": [],
    "other_names": []
}

Other providers in Hamilton, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.