Provider Demographics
NPI:1467870535
Name:WARBIRD LAB SERVICES LLC
Entity Type:Organization
Organization Name:WARBIRD LAB SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:DYLAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-506-9482
Mailing Address - Street 1:555 HERITAGE DR
Mailing Address - Street 2:STE 121
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-5285
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4000 S 57TH AVE
Practice Address - Street 2:STE 203
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33463-4307
Practice Address - Country:US
Practice Address - Phone:516-506-9482
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-04
Last Update Date:2014-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL800027175291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory