Provider Demographics
NPI:1568950194
Name:SOUTH JERSEY TOXICOLOGY, LLC
Entity Type:Organization
Organization Name:SOUTH JERSEY TOXICOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LAB DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIENBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-265-6734
Mailing Address - Street 1:1040 WILLOW CREEK RD.
Mailing Address - Street 2:A 101-462
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1000 HADDONFIELD BERLIN RD STE 120
Practice Address - Street 2:
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-3520
Practice Address - Country:US
Practice Address - Phone:856-454-7690
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-30
Last Update Date:2018-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory