Provider Demographics
NPI:1871245126
Name:PROLABS DIAGNOSTICS
Entity Type:Organization
Organization Name:PROLABS DIAGNOSTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NARDIA MCKOY RN
Authorized Official - Prefix:MRS
Authorized Official - First Name:NARDIA
Authorized Official - Middle Name:STACYANN
Authorized Official - Last Name:MCKOY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:860-655-6628
Mailing Address - Street 1:389 WOODLAND ST FL 3
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06112-2134
Mailing Address - Country:US
Mailing Address - Phone:860-655-6628
Mailing Address - Fax:
Practice Address - Street 1:389 WOODLAND ST FL 3
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06112-2134
Practice Address - Country:US
Practice Address - Phone:860-655-6628
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-18
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory