Provider Demographics
NPI:1134474505
Name:GDSL, INC
Entity Type:Organization
Organization Name:GDSL, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BAILYNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-201-7713
Mailing Address - Street 1:677 CRESTA CIRCLE
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33413-1047
Mailing Address - Country:US
Mailing Address - Phone:561-201-7713
Mailing Address - Fax:
Practice Address - Street 1:14000 S MILITARY TRL
Practice Address - Street 2:SUITE 211 B
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-2610
Practice Address - Country:US
Practice Address - Phone:561-201-7713
Practice Address - Fax:561-328-7496
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-20
Last Update Date:2014-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory