Provider Demographics
NPI:1285039008
Name:CENTRAL LAB LLC
Entity Type:Organization
Organization Name:CENTRAL LAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:NAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:SRIVASTAVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-374-8555
Mailing Address - Street 1:454 W VALLEY AVE
Mailing Address - Street 2:
Mailing Address - City:ELYSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17824-7247
Mailing Address - Country:US
Mailing Address - Phone:570-672-1111
Mailing Address - Fax:570-672-1100
Practice Address - Street 1:454 W VALLEY AVE
Practice Address - Street 2:
Practice Address - City:ELYSBURG
Practice Address - State:PA
Practice Address - Zip Code:17824-7247
Practice Address - Country:US
Practice Address - Phone:570-672-1111
Practice Address - Fax:570-672-1100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-23
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory