Provider Demographics
NPI:1790066009
Name:EZLAB LLC
Entity Type:Organization
Organization Name:EZLAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:ZIMMERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-874-4615
Mailing Address - Street 1:2901 SW 149TH AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-4151
Mailing Address - Country:US
Mailing Address - Phone:954-874-4615
Mailing Address - Fax:954-874-3376
Practice Address - Street 1:2901 SW 149TH AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-4151
Practice Address - Country:US
Practice Address - Phone:954-874-4615
Practice Address - Fax:954-874-3376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-31
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory