Provider Demographics
NPI:1518381029
Name:CLINICAL MEDICAL LABORATORY LLC
Entity Type:Organization
Organization Name:CLINICAL MEDICAL LABORATORY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGR
Authorized Official - Prefix:
Authorized Official - First Name:LUCY
Authorized Official - Middle Name:
Authorized Official - Last Name:VASQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-321-1100
Mailing Address - Street 1:22 MERIDIAN RD
Mailing Address - Street 2:SUITE 7
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-2860
Mailing Address - Country:US
Mailing Address - Phone:732-321-1100
Mailing Address - Fax:732-321-1150
Practice Address - Street 1:2000 CABOT BLVD W
Practice Address - Street 2:SUITE 110
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-2407
Practice Address - Country:US
Practice Address - Phone:215-228-0200
Practice Address - Fax:732-321-1150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-05
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory