Provider Demographics
NPI:1346641875
Name:EM1 LABS, LLC
Entity Type:Organization
Organization Name:EM1 LABS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER (CFO)
Authorized Official - Prefix:
Authorized Official - First Name:ANGELO
Authorized Official - Middle Name:
Authorized Official - Last Name:SKULAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-380-8488
Mailing Address - Street 1:3115 NW 10TH TER STE 108
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-5937
Mailing Address - Country:US
Mailing Address - Phone:561-223-3269
Mailing Address - Fax:
Practice Address - Street 1:3115 NW 10TH TER STE 108
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309-5937
Practice Address - Country:US
Practice Address - Phone:561-223-3269
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-16
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
291U00000X
FL10D2079549291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL019446800Medicaid