Provider Demographics
NPI:1891161311
Name:MY LAB CHOICE, INC.
Entity Type:Organization
Organization Name:MY LAB CHOICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORGANIZATION OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:LEONID
Authorized Official - Middle Name:
Authorized Official - Last Name:KOSYAKOVSKIY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-872-9800
Mailing Address - Street 1:364 NORTH COURTLAND STREET
Mailing Address - Street 2:
Mailing Address - City:EAST STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18301
Mailing Address - Country:US
Mailing Address - Phone:570-872-9800
Mailing Address - Fax:
Practice Address - Street 1:364 N COURTLAND ST
Practice Address - Street 2:
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-1930
Practice Address - Country:US
Practice Address - Phone:570-872-9800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-19
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory