Provider Demographics
NPI:1366468027
Name:MEDLAB INC
Entity Type:Organization
Organization Name:MEDLAB INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:B
Authorized Official - Last Name:NAGOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-633-8001
Mailing Address - Street 1:600 CAYUGA RD
Mailing Address - Street 2:
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14225-1305
Mailing Address - Country:US
Mailing Address - Phone:716-633-8001
Mailing Address - Fax:716-633-8032
Practice Address - Street 1:600 CAYUGA RD
Practice Address - Street 2:
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14225-1305
Practice Address - Country:US
Practice Address - Phone:716-633-8001
Practice Address - Fax:716-633-8032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2010-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYLAP 34286291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01399146Medicaid
NY076145Medicare ID - Type UnspecifiedLABORATORY