Provider Demographics
NPI:1316389158
Name:SJ PENNJE LABORATORY SERVICES, LLC
Entity Type:Organization
Organization Name:SJ PENNJE LABORATORY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMED
Authorized Official - Middle Name:A
Authorized Official - Last Name:ABDULLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD, FCAP
Authorized Official - Phone:609-407-1220
Mailing Address - Street 1:3205 FIRE RD
Mailing Address - Street 2:SUITE P1
Mailing Address - City:EGG HARBOR TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08234-5884
Mailing Address - Country:US
Mailing Address - Phone:609-407-1220
Mailing Address - Fax:609-677-5489
Practice Address - Street 1:3205 FIRE RD
Practice Address - Street 2:SUITE P1
Practice Address - City:EGG HARBOR TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08234-5884
Practice Address - Country:US
Practice Address - Phone:609-407-1220
Practice Address - Fax:609-677-5489
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-22
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory