Provider Demographics
NPI:1679745277
Name:CLB MEDICAL SERVICES PC
Entity Type:Organization
Organization Name:CLB MEDICAL SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CORDIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:BEVERLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD,
Authorized Official - Phone:212-876-1886
Mailing Address - Street 1:1085 PARK AVE
Mailing Address - Street 2:SUITE 1N
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-1168
Mailing Address - Country:US
Mailing Address - Phone:212-876-1886
Mailing Address - Fax:
Practice Address - Street 1:1085 PARK AVE
Practice Address - Street 2:SUITE 1N
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-1168
Practice Address - Country:US
Practice Address - Phone:212-876-1886
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-24
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY130612207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB79244Medicare UPIN
NY75A311Medicare PIN