Provider Demographics
NPI:1740731769
Name:BURLINGTON LABS ACQUISITION, LLC
Entity type:Organization
Organization Name:BURLINGTON LABS ACQUISITION, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:CHERIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PHILIP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-863-4105
Mailing Address - Street 1:199 MAIN ST
Mailing Address - Street 2:SUITE 226
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-8309
Mailing Address - Country:US
Mailing Address - Phone:802-863-4105
Mailing Address - Fax:802-448-3196
Practice Address - Street 1:199 MAIN ST
Practice Address - Street 2:SUITE 226
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-8309
Practice Address - Country:US
Practice Address - Phone:802-863-4105
Practice Address - Fax:802-448-3196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-14
Last Update Date:2016-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory