Provider Demographics
NPI:1518562784
Name:SUNSHINE LABORATORY LLC
Entity Type:Organization
Organization Name:SUNSHINE LABORATORY LLC
Other - Org Name:SUNSHINE LABORATORY LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:RAJEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHUKLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-236-1475
Mailing Address - Street 1:181 US HIGHWAY 22
Mailing Address - Street 2:
Mailing Address - City:GREEN BROOK
Mailing Address - State:NJ
Mailing Address - Zip Code:08812-1901
Mailing Address - Country:US
Mailing Address - Phone:732-236-1475
Mailing Address - Fax:
Practice Address - Street 1:181 ROUTE 22 E
Practice Address - Street 2:
Practice Address - City:GREEN BROOK
Practice Address - State:NJ
Practice Address - Zip Code:08812-1901
Practice Address - Country:US
Practice Address - Phone:732-529-5830
Practice Address - Fax:732-529-5829
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-03
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0832618Medicaid