Provider Demographics
NPI:1568483535
Name:GUARDIAN CLINICAL LABORATORIES LLC
Entity Type:Organization
Organization Name:GUARDIAN CLINICAL LABORATORIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LABORATORY DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ELIAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:KHABBAZA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:631-424-1807
Mailing Address - Street 1:232 E MAIN ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-2920
Mailing Address - Country:US
Mailing Address - Phone:631-424-1807
Mailing Address - Fax:631-424-0762
Practice Address - Street 1:232 E MAIN ST
Practice Address - Street 2:SUITE 1
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-2920
Practice Address - Country:US
Practice Address - Phone:631-424-1807
Practice Address - Fax:631-424-0762
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7402291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
1568483535OtherRAIL ROAD MEDICARE
NY94249OtherVYTRA
NYA1235192OtherOXFORD
NYN45663OtherHEALTHNET
1568483535OtherRAIL ROAD MEDICARE