Provider Demographics
NPI:1780041475
Name:CT LABS LLC
Entity Type:Organization
Organization Name:CT LABS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCOS
Authorized Official - Middle Name:
Authorized Official - Last Name:DE ESCOBAR
Authorized Official - Suffix:
Authorized Official - Credentials:NMD
Authorized Official - Phone:203-757-9336
Mailing Address - Street 1:417 HIGHLAND AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708-3454
Mailing Address - Country:US
Mailing Address - Phone:203-757-9336
Mailing Address - Fax:888-532-1877
Practice Address - Street 1:417 HIGHLAND AVE STE 2
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-3454
Practice Address - Country:US
Practice Address - Phone:203-757-9336
Practice Address - Fax:888-532-1877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-26
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTMD971566291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory