Provider Demographics
NPI:1558440768
Name:SNAP LABORATORIES INTERNATIONAL, LLC
Entity Type:Organization
Organization Name:SNAP LABORATORIES INTERNATIONAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GIL
Authorized Official - Middle Name:
Authorized Official - Last Name:RAVIV
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:847-777-0000
Mailing Address - Street 1:5210 CAPITOL DR
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:IL
Mailing Address - Zip Code:60090-7901
Mailing Address - Country:US
Mailing Address - Phone:847-777-0000
Mailing Address - Fax:847-465-3404
Practice Address - Street 1:5210 CAPITOL DR
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:IL
Practice Address - Zip Code:60090-7901
Practice Address - Country:US
Practice Address - Phone:847-777-0000
Practice Address - Fax:847-465-3404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILWR000335293D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========OtherTAX IDENTIFICATION NUMBER