Provider Demographics
NPI:1407923568
Name:BIODIAGNOSTIC LABORATORY SERVICES,LLC.
Entity Type:Organization
Organization Name:BIODIAGNOSTIC LABORATORY SERVICES,LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:NICOLL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-244-1601
Mailing Address - Street 1:181 NEW RD # 307
Mailing Address - Street 2:
Mailing Address - City:PARSIPPANY
Mailing Address - State:NJ
Mailing Address - Zip Code:07054-5625
Mailing Address - Country:US
Mailing Address - Phone:973-244-1601
Mailing Address - Fax:973-244-1606
Practice Address - Street 1:181 NEW RD # 307
Practice Address - Street 2:
Practice Address - City:PARSIPPANY
Practice Address - State:NJ
Practice Address - Zip Code:07054-5625
Practice Address - Country:US
Practice Address - Phone:973-244-1601
Practice Address - Fax:973-244-1606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0061352Medicaid
NJ099247Medicare PIN