Provider Demographics
NPI:1467761320
Name:GLEESON CO INC
Entity Type:Organization
Organization Name:GLEESON CO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KAMOLIDDIN
Authorized Official - Middle Name:
Authorized Official - Last Name:AKRAMOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-787-6080
Mailing Address - Street 1:14434 HAMLIN ST
Mailing Address - Street 2:STE 3
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91401-1461
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14434 HAMLIN ST
Practice Address - Street 2:STE 3
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91401-1461
Practice Address - Country:US
Practice Address - Phone:818-787-6080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-27
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA05D2012667291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory