Medical Diagnostic Group Lab

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

CLIA33D0653745 Issued in NY

Legal business name

MEDICAL DIAGNOSTIC GROUP LAB

Practice address

210 E Main St
Middletown, NY 10940-4038

Phone

(845) 342-5681

Fax

(845) 342-0470

NPI assigned

May 25, 2007

Last updated

May 22, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Elliott T Friedman, M.D.

Title

Lab Director

Phone

(845) 342-5681

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1180051200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1211414400000",
    "number": "1760693337",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "210 E MAIN ST",
            "city": "MIDDLETOWN",
            "state": "NY",
            "postal_code": "109404038",
            "telephone_number": "845-342-5681",
            "fax_number": "845-342-0470"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 E MAIN ST",
            "city": "MIDDLETOWN",
            "state": "NY",
            "postal_code": "109404038",
            "telephone_number": "845-342-5681",
            "fax_number": "845-342-0470"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICAL DIAGNOSTIC GROUP LAB",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-25",
        "last_updated": "2008-05-22",
        "status": "A",
        "authorized_official_last_name": "FRIEDMAN",
        "authorized_official_first_name": "ELLIOTT",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "LAB DIRECTOR",
        "authorized_official_telephone_number": "845-342-5681",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "NY",
            "license": "CLIA33D0653745",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Medical Laboratory in Middletown, NY
• Providers in Middletown, NY by specialty
• Clinical Medical Laboratory in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2008; 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.