Provider Demographics
NPI:1598820235
Name:SHERMAN ABRAMS LABORATORY INC
Entity Type:Organization
Organization Name:SHERMAN ABRAMS LABORATORY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:YAKOV
Authorized Official - Middle Name:
Authorized Official - Last Name:LEYBOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-435-7200
Mailing Address - Street 1:63 FLUSHING AVE UNIT 292
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11205-1079
Mailing Address - Country:US
Mailing Address - Phone:718-435-7200
Mailing Address - Fax:718-438-1788
Practice Address - Street 1:524 WILLIAMSTOWN RD
Practice Address - Street 2:
Practice Address - City:SICKLERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08081-1800
Practice Address - Country:US
Practice Address - Phone:718-435-7200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-22
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPFI3534291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00289354Medicaid
NY00289354Medicaid
C06581Medicare UPIN