Provider Demographics
NPI:1225110497
Name:ACCU REFERENCE MEDICAL LAB, LLC
Entity Type:Organization
Organization Name:ACCU REFERENCE MEDICAL LAB, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF COMPLIANCE OFFIER
Authorized Official - Prefix:
Authorized Official - First Name:LUZ
Authorized Official - Middle Name:
Authorized Official - Last Name:BAGLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-474-1004
Mailing Address - Street 1:1901 E LINDEN AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:LINDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07036-1114
Mailing Address - Country:US
Mailing Address - Phone:908-474-1004
Mailing Address - Fax:908-474-0032
Practice Address - Street 1:1901 E LINDEN AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:LINDEN
Practice Address - State:NJ
Practice Address - Zip Code:07036
Practice Address - Country:US
Practice Address - Phone:908-474-1004
Practice Address - Fax:908-474-0032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ00006645291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0084425Medicaid
NJ571083Medicaid