Provider Demographics
NPI:1821110453
Name:DART MEDICAL LABORATORY, INC
Entity Type:Organization
Organization Name:DART MEDICAL LABORATORY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:GALINA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLUB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-538-8418
Mailing Address - Street 1:140 58TH ST, BUILDING A
Mailing Address - Street 2:UNIT 3L
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220
Mailing Address - Country:US
Mailing Address - Phone:718-934-1918
Mailing Address - Fax:718-934-2003
Practice Address - Street 1:140 58TH ST, BUILDING A
Practice Address - Street 2:UNIT 3L
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220
Practice Address - Country:US
Practice Address - Phone:718-934-1918
Practice Address - Fax:718-934-2003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY33D1020120291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
LC1841Medicare ID - Type Unspecified