Provider Demographics
NPI:1114501707
Name:PEPTINEO LLC
Entity Type:Organization
Organization Name:PEPTINEO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LABORATORY DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SHELDON
Authorized Official - Middle Name:
Authorized Official - Last Name:JORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:855-385-5246
Mailing Address - Street 1:5901 INDIAN SCHOOL RD NE
Mailing Address - Street 2:STE 208
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-5200
Mailing Address - Country:US
Mailing Address - Phone:855-385-5246
Mailing Address - Fax:
Practice Address - Street 1:5901 INDIAN SCHOOL RD NE STE 208
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-5200
Practice Address - Country:US
Practice Address - Phone:855-385-5246
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-10
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory