Provider Demographics
NPI:1598763914
Name:NRI LABORATORIES INC
Entity Type:Organization
Organization Name:NRI LABORATORIES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:REYNALDO
Authorized Official - Middle Name:
Authorized Official - Last Name:ILAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:PRESIDENT
Authorized Official - Phone:773-773-6743
Mailing Address - Street 1:5960 N MILWAUKEE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60646-5424
Mailing Address - Country:US
Mailing Address - Phone:773-775-6743
Mailing Address - Fax:773-775-6673
Practice Address - Street 1:5960 N MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60646-5424
Practice Address - Country:US
Practice Address - Phone:773-775-6743
Practice Address - Fax:773-775-6673
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-09
Last Update Date:2010-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL14D0646644291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001633071OtherBCBS - IL
IL244163OtherHARMONY HEALTH PLAN
IL244163OtherHARMONY HEALTH PLAN
IL=========OtherMULTIPLAN NETWORK
IL=========OtherTAX PAYER ID NUMBER
IL=========OtherBEECH STREET NETWORK
IL=========001Medicaid