Provider Demographics
NPI:1841754421
Name:TGM LABS LLC
Entity Type:Organization
Organization Name:TGM LABS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KIVIAT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-512-9685
Mailing Address - Street 1:1000 GERMANTOWN PIKE STE E3
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH MEETING
Mailing Address - State:PA
Mailing Address - Zip Code:19462-2485
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1000 GERMANTOWN PIKE STE E3
Practice Address - Street 2:
Practice Address - City:PLYMOUTH MEETING
Practice Address - State:PA
Practice Address - Zip Code:19462-2485
Practice Address - Country:US
Practice Address - Phone:561-512-9685
Practice Address - Fax:561-562-3719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-28
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory