Provider Demographics
NPI:1366487233
Name:LENETIX MEDICAL SCREENING LABORATORY
Entity Type:Organization
Organization Name:LENETIX MEDICAL SCREENING LABORATORY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:H
Authorized Official - Last Name:KELLNER
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:516-248-0036
Mailing Address - Street 1:174 MINEOLA BLVD
Mailing Address - Street 2:STE 1
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-2513
Mailing Address - Country:US
Mailing Address - Phone:516-248-0036
Mailing Address - Fax:516-248-4436
Practice Address - Street 1:174 MINEOLA BLVD
Practice Address - Street 2:STE 1
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-2513
Practice Address - Country:US
Practice Address - Phone:516-248-0036
Practice Address - Fax:516-248-4436
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02698231Medicaid
NC7001267Medicaid
PA1013885690001Medicaid
TN4490741Medicaid
OH2579302Medicaid
CT3133379Medicaid
OH2579302Medicaid