Provider Demographics
NPI:1518098235
Name:ASTRACLINICALLABORATORYINC
Entity Type:Organization
Organization Name:ASTRACLINICALLABORATORYINC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MISS
Authorized Official - First Name:ELEANOR
Authorized Official - Middle Name:REYES
Authorized Official - Last Name:BARISO
Authorized Official - Suffix:
Authorized Official - Credentials:MTASCP
Authorized Official - Phone:718-592-8948
Mailing Address - Street 1:5816 JUNCTION BLVD
Mailing Address - Street 2:F3
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11373-5155
Mailing Address - Country:US
Mailing Address - Phone:718-592-8948
Mailing Address - Fax:718-592-8949
Practice Address - Street 1:5816 JUNCTION BLVD
Practice Address - Street 2:F3
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11373-5155
Practice Address - Country:US
Practice Address - Phone:718-592-8948
Practice Address - Fax:718-592-8949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY33D0713273291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY77312Medicare PIN