Provider Demographics
NPI:1558538264
Name:GENLAB CORPORATION
Entity Type:Organization
Organization Name:GENLAB CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:PABRIAGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-539-1500
Mailing Address - Street 1:131 1ST ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60108-1219
Mailing Address - Country:US
Mailing Address - Phone:630-539-1500
Mailing Address - Fax:630-539-0500
Practice Address - Street 1:131 1ST ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-1219
Practice Address - Country:US
Practice Address - Phone:630-539-1500
Practice Address - Fax:630-539-0500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-12
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL14D1082277291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory