Provider Demographics
NPI:1871244509
Name:JLS DIAGNOSTICS
Entity Type:Organization
Organization Name:JLS DIAGNOSTICS
Other - Org Name:N/A
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAVON
Authorized Official - Middle Name:LASHANDA
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:BSN, RN
Authorized Official - Phone:856-571-3312
Mailing Address - Street 1:115 S CEDAR AVE
Mailing Address - Street 2:LEVEL 1
Mailing Address - City:MAPLE SHADE
Mailing Address - State:NJ
Mailing Address - Zip Code:08052
Mailing Address - Country:US
Mailing Address - Phone:856-571-3312
Mailing Address - Fax:800-418-1917
Practice Address - Street 1:115 S CEDAR AVE
Practice Address - Street 2:LEVEL 1
Practice Address - City:MAPLE SHADE
Practice Address - State:NJ
Practice Address - Zip Code:08052
Practice Address - Country:US
Practice Address - Phone:856-571-3312
Practice Address - Fax:800-418-1917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-13
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory