Avantic Medical Lab

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

AVANTIC MEDICAL LAB

Practice address

3880 Park Ave Unit 100
Edison, NJ 08820-3012

Phone

(732) 474-1120

NPI assigned

May 21, 2018

Organization subpart

No

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

Authorized official

Name

Edward S. Liu

Title

Director

Phone

(732) 474-1120

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NJ

Enrollment records 1

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

CLIA laboratory certificates

Locations

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

{
    "created_epoch": "1526860800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1693440000000",
    "number": "1972094423",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3880 PARK AVE UNIT 100",
            "city": "EDISON",
            "state": "NJ",
            "postal_code": "088203012",
            "telephone_number": "732-474-1120"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3880 PARK AVE UNIT 100",
            "city": "EDISON",
            "state": "NJ",
            "postal_code": "088203012",
            "telephone_number": "732-474-1120"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AVANTIC MEDICAL LAB",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-05-21",
        "last_updated": "2023-08-31",
        "certification_date": "2023-08-31",
        "status": "A",
        "authorized_official_last_name": "LIU",
        "authorized_official_first_name": "EDWARD",
        "authorized_official_middle_name": "S.",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "732-474-1120"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0682543",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Clinical Medical Laboratory in Edison, NJ
• Providers in Edison, 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 31, 2023; 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.