Provider Demographics
NPI:1659744654
Name:AERIS LABORATORY
Entity Type:Organization
Organization Name:AERIS LABORATORY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:K.A.
Authorized Official - Middle Name:T
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-525-6275
Mailing Address - Street 1:PO BOX 57286
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-7286
Mailing Address - Country:US
Mailing Address - Phone:281-525-6275
Mailing Address - Fax:
Practice Address - Street 1:100 E. NASA PKWY
Practice Address - Street 2:STE 408B
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-5206
Practice Address - Country:US
Practice Address - Phone:281-525-6104
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-12
Last Update Date:2016-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory