Provider Demographics
NPI:1750445284
Name:ANALYTICAL DIAGNOSTIC LABS,INC
Entity Type:Organization
Organization Name:ANALYTICAL DIAGNOSTIC LABS,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GERSHON
Authorized Official - Middle Name:
Authorized Official - Last Name:SONTAG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-646-6000
Mailing Address - Street 1:2115 AVENUE X
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-2910
Mailing Address - Country:US
Mailing Address - Phone:718-646-6000
Mailing Address - Fax:718-934-5852
Practice Address - Street 1:2115 AVENUE X
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-2910
Practice Address - Country:US
Practice Address - Phone:718-646-6000
Practice Address - Fax:718-934-5852
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3804291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory