Provider Demographics
NPI:1649765660
Name:SPARK INSPIRATION LABORATORY LLC
Entity Type:Organization
Organization Name:SPARK INSPIRATION LABORATORY LLC
Other - Org Name:SPARK LABORATORY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:WECHSLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-406-6483
Mailing Address - Street 1:101 NE 54TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33137-2415
Mailing Address - Country:US
Mailing Address - Phone:201-406-6483
Mailing Address - Fax:
Practice Address - Street 1:101 NE 54TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33137-2415
Practice Address - Country:US
Practice Address - Phone:201-406-6483
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-22
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory