Provider Demographics
NPI:1558618272
Name:SPECIALIZED SCREENING SERVICES
Entity Type:Organization
Organization Name:SPECIALIZED SCREENING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESUDENT
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:LUSTBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:878-727-3365
Mailing Address - Street 1:10 SARATOGA DR
Mailing Address - Street 2:
Mailing Address - City:JERICHO
Mailing Address - State:NY
Mailing Address - Zip Code:11753-1430
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10 SARATOGA DR
Practice Address - Street 2:
Practice Address - City:JERICHO
Practice Address - State:NY
Practice Address - Zip Code:11753-1430
Practice Address - Country:US
Practice Address - Phone:877-727-3365
Practice Address - Fax:914-509-5438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-13
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY33D1092705291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory