Provider Demographics
NPI:1679874267
Name:ABC LAB
Entity Type:Organization
Organization Name:ABC LAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:LANA
Authorized Official - Middle Name:
Authorized Official - Last Name:MALINKOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-376-1004
Mailing Address - Street 1:1616 E 13TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-1102
Mailing Address - Country:US
Mailing Address - Phone:718-376-1004
Mailing Address - Fax:718-954-3769
Practice Address - Street 1:1616 E 13TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-1102
Practice Address - Country:US
Practice Address - Phone:718-376-1004
Practice Address - Fax:718-954-3769
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SL QUALITY CARE DIAGNOSTIC & TREATMENT CNETER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-11-12
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory