Provider Demographics
NPI:1821492570
Name:THE ELITE LABS GROUP PA
Entity Type:Organization
Organization Name:THE ELITE LABS GROUP PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:WADDINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-757-1880
Mailing Address - Street 1:PO BOX 7193
Mailing Address - Street 2:
Mailing Address - City:PENNDEL
Mailing Address - State:PA
Mailing Address - Zip Code:19047-7193
Mailing Address - Country:US
Mailing Address - Phone:215-757-1880
Mailing Address - Fax:
Practice Address - Street 1:1400 VETERANS HWY
Practice Address - Street 2:SUITE 108
Practice Address - City:LEVITTOWN
Practice Address - State:PA
Practice Address - Zip Code:19056-2115
Practice Address - Country:US
Practice Address - Phone:215-757-1800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-09
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory