Provider Demographics
NPI:1003281890
Name:JAYDE LABORATORIES LLC
Entity Type:Organization
Organization Name:JAYDE LABORATORIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ADRIAN
Authorized Official - Middle Name:SHEROD
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-324-2174
Mailing Address - Street 1:1977 BRANDYWINE RD
Mailing Address - Street 2:#204
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33409-6808
Mailing Address - Country:US
Mailing Address - Phone:336-324-2174
Mailing Address - Fax:
Practice Address - Street 1:555 HERITAGE DR
Practice Address - Street 2:#140
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-5285
Practice Address - Country:US
Practice Address - Phone:561-714-8401
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-05
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory