Provider Demographics
NPI:1619584596
Name:EQ LABS
Entity Type:Organization
Organization Name:EQ LABS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:VOYTEK
Authorized Official - Middle Name:
Authorized Official - Last Name:FABER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-513-8998
Mailing Address - Street 1:851 BROKEN SOUND PKWY NW STE 125
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33487-3628
Mailing Address - Country:US
Mailing Address - Phone:561-295-8946
Mailing Address - Fax:
Practice Address - Street 1:851 BROKEN SOUND PKWY NW STE 125
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33487-3628
Practice Address - Country:US
Practice Address - Phone:561-295-8946
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-25
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1100XAmbulatory Health Care FacilitiesClinic/CenterResearch