Provider Demographics
NPI:1801982756
Name:CEDARS DIAGNOSTIC LABS INC
Entity type:Organization
Organization Name:CEDARS DIAGNOSTIC LABS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:BALTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-354-1222
Mailing Address - Street 1:5422 CARRIER DR
Mailing Address - Street 2:SUITE 306
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-8394
Mailing Address - Country:US
Mailing Address - Phone:407-354-1222
Mailing Address - Fax:407-354-0065
Practice Address - Street 1:5422 CARRIER DR
Practice Address - Street 2:SUITE 306
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-8394
Practice Address - Country:US
Practice Address - Phone:407-354-1222
Practice Address - Fax:407-354-0065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonographyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE2233Medicare PIN