Provider Demographics
NPI:1821623703
Name:DJ LAB LLC
Entity Type:Organization
Organization Name:DJ LAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-566-2075
Mailing Address - Street 1:2550 BRODHEAD RD STE 202
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18020-8922
Mailing Address - Country:US
Mailing Address - Phone:267-566-2075
Mailing Address - Fax:267-358-5979
Practice Address - Street 1:2550 BRODHEAD RD STE 202
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18020-8922
Practice Address - Country:US
Practice Address - Phone:267-566-2075
Practice Address - Fax:267-358-5979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-11
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory