Excelsior Diagnostic Laboratories

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

00041703 Issued in NJ

Legal business name

EXCELSIOR DIAGNOSTIC LABORATORIES

Practice address

2720 Route 27
North Brunswick, NJ 08902-1029

Phone

(718) 702-7843

NPI assigned

Apr 14, 2016

Organization subpart

No

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

Authorized official

Name

Irfan S Chaudhry

Title

President

Phone

(917) 364-9486

Specialties & licenses 1

Addresses

Other identifiers 1

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": "1460592000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1668556800000",
    "number": "1902250186",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2720 ROUTE 27",
            "city": "NORTH BRUNSWICK",
            "state": "NJ",
            "postal_code": "089021029"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2720 ROUTE 27",
            "city": "NORTH BRUNSWICK",
            "state": "NJ",
            "postal_code": "089021029",
            "telephone_number": "718-702-7843"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXCELSIOR DIAGNOSTIC LABORATORIES",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-04-14",
        "last_updated": "2022-11-16",
        "certification_date": "2022-11-16",
        "status": "A",
        "authorized_official_last_name": "CHAUDHRY",
        "authorized_official_first_name": "IRFAN",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "917-364-9486"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "NJ",
            "license": "00041703",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIS",
            "identifier": "0008740",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Clinical Medical Laboratory in North Brunswick, NJ
• Providers in North Brunswick, 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 Nov 16, 2022; 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.