Provider Demographics
NPI:1659817849
Name:OB GYN ASSOCIATES OF ERIE LABORATORY LLC
Entity Type:Organization
Organization Name:OB GYN ASSOCIATES OF ERIE LABORATORY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER ENROLLMENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:DENOFRIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-459-1851
Mailing Address - Street 1:100 PEACH ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16507-1423
Mailing Address - Country:US
Mailing Address - Phone:814-459-1851
Mailing Address - Fax:814-456-0541
Practice Address - Street 1:100 PEACH ST
Practice Address - Street 2:SUITE 202
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16507-1423
Practice Address - Country:US
Practice Address - Phone:814-459-1851
Practice Address - Fax:814-456-0541
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-11
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA39D0679874291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory