Provider Demographics
NPI:1407290158
Name:QUEST DIAGNOSTICS CLINICAL LABORATORIES INC
Entity Type:Organization
Organization Name:QUEST DIAGNOSTICS CLINICAL LABORATORIES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF REVENUE SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:J PABLO
Authorized Official - Middle Name:
Authorized Official - Last Name:LAKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-697-8378
Mailing Address - Street 1:1001 ADAMS AVE
Mailing Address - Street 2:MRGOV 2ND FLOOR
Mailing Address - City:NORRISTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19403-2429
Mailing Address - Country:US
Mailing Address - Phone:866-697-8378
Mailing Address - Fax:
Practice Address - Street 1:CARR 931 KM 5.6
Practice Address - Street 2:BO. NAVARRO SECT. CIELITO
Practice Address - City:GURABO
Practice Address - State:PR
Practice Address - Zip Code:00778-0000
Practice Address - Country:US
Practice Address - Phone:787-258-0640
Practice Address - Fax:787-746-6939
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:QUEST DIAGNOSTICS INCORPORATED
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-04-24
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory