Provider Demographics
NPI:1497439277
Name:EXTRACT LABS & DIAGNOSTICS
Entity Type:Organization
Organization Name:EXTRACT LABS & DIAGNOSTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:EBONY
Authorized Official - Middle Name:STEPHANIE
Authorized Official - Last Name:LORA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-851-9037
Mailing Address - Street 1:1841 ROUTE 209 STE 103
Mailing Address - Street 2:
Mailing Address - City:BRODHEADSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18322-7133
Mailing Address - Country:US
Mailing Address - Phone:347-851-9037
Mailing Address - Fax:
Practice Address - Street 1:1841 ROUTE 209 STE 103
Practice Address - Street 2:
Practice Address - City:BRODHEADSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18322-7133
Practice Address - Country:US
Practice Address - Phone:347-851-9037
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-13
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomyGroup - Single Specialty