Provider Demographics
NPI:1104363746
Name:ELITE DIAGNOSTICS LABS, INC
Entity Type:Organization
Organization Name:ELITE DIAGNOSTICS LABS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:WU
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:844-854-8556
Mailing Address - Street 1:1130 HURRICANE SHOALS RD NE
Mailing Address - Street 2:SUITE 1300
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-4851
Mailing Address - Country:US
Mailing Address - Phone:844-854-8556
Mailing Address - Fax:770-338-1994
Practice Address - Street 1:1130 HURRICANE SHOALS RD NE
Practice Address - Street 2:SUITE 1300
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30043-4851
Practice Address - Country:US
Practice Address - Phone:844-854-8556
Practice Address - Fax:770-338-1994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-20
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory