Provider Demographics
NPI:1558575654
Name:DIAGNOSTIC LABORATOY SERVICES
Entity Type:Organization
Organization Name:DIAGNOSTIC LABORATOY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:J
Authorized Official - Last Name:ZINTERHOFER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-229-8711
Mailing Address - Street 1:300 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BRANCH
Mailing Address - State:NJ
Mailing Address - Zip Code:07740-6303
Mailing Address - Country:US
Mailing Address - Phone:732-229-8711
Mailing Address - Fax:732-229-0245
Practice Address - Street 1:279 3RD AVE STE 104
Practice Address - Street 2:
Practice Address - City:LONG BRANCH
Practice Address - State:NJ
Practice Address - Zip Code:07740-6205
Practice Address - Country:US
Practice Address - Phone:732-229-8711
Practice Address - Fax:732-229-0245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA27692291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3824705Medicaid
NJ3824705Medicaid
NJ3824705Medicaid