Provider Demographics
NPI:1598860082
Name:CLINICAL LABORATORY MANANGEMENT, INC
Entity Type:Organization
Organization Name:CLINICAL LABORATORY MANANGEMENT, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR BUSINESS OPERATI
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:C
Authorized Official - Last Name:PECKHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-810-1113
Mailing Address - Street 1:PO BOX 1806
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-1806
Mailing Address - Country:US
Mailing Address - Phone:908-810-1113
Mailing Address - Fax:908-810-1109
Practice Address - Street 1:2124 MORRIS AVE
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-6042
Practice Address - Country:US
Practice Address - Phone:908-810-1113
Practice Address - Fax:908-810-1109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2009-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA028999291U00000X
NYPFI7930291U00000X
DE291U00000X
NJ00007510291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ043750Medicare PIN