Provider Demographics
NPI:1124022199
Name:DOWNSTATE CLINICAL LABORATORIES INC
Entity Type:Organization
Organization Name:DOWNSTATE CLINICAL LABORATORIES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LEWIS
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:SCALIONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-693-0401
Mailing Address - Street 1:2209 HILLSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-2714
Mailing Address - Country:US
Mailing Address - Phone:516-693-0401
Mailing Address - Fax:516-693-0404
Practice Address - Street 1:2209 HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-2714
Practice Address - Country:US
Practice Address - Phone:516-693-0401
Practice Address - Fax:516-693-0404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-08
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4345 33D0711978291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYL10692Medicare ID - Type Unspecified