Provider Demographics
NPI:1508863713
Name:MILFORD MEDICAL LABORATORY, INC.
Entity Type:Organization
Organization Name:MILFORD MEDICAL LABORATORY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:E
Authorized Official - Last Name:MOSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-876-4230
Mailing Address - Street 1:2068 BRIDGEPORT AVE
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-4634
Mailing Address - Country:US
Mailing Address - Phone:203-876-7745
Mailing Address - Fax:203-877-8319
Practice Address - Street 1:2068 BRIDGEPORT AVE
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-4634
Practice Address - Country:US
Practice Address - Phone:203-876-7745
Practice Address - Fax:203-877-8319
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTCL-0502291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTCL-0502OtherSTATE LICENSE NUMBER
CT721623OtherCONNECTICARE ID NUMBER