Provider Demographics
NPI:1568245546
Name:TEL-A-LAB
Entity Type:Organization
Organization Name:TEL-A-LAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:KEDESTY
Authorized Official - Middle Name:TESFAI
Authorized Official - Last Name:TELLA
Authorized Official - Suffix:
Authorized Official - Credentials:MS, ASCP
Authorized Official - Phone:585-455-7623
Mailing Address - Street 1:318 AVENUE E APT 315
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-6497
Mailing Address - Country:US
Mailing Address - Phone:585-455-7623
Mailing Address - Fax:
Practice Address - Street 1:318 AVENUE E APT 315
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-6497
Practice Address - Country:US
Practice Address - Phone:585-455-7623
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-15
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomyGroup - Single Specialty