Provider Demographics
NPI:1922624824
Name:PHLEB EXPRESS
Entity Type:Organization
Organization Name:PHLEB EXPRESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRINISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:SANJURJO
Authorized Official - Suffix:
Authorized Official - Credentials:MEDICAL ASSISTANT
Authorized Official - Phone:315-706-7458
Mailing Address - Street 1:7285 STATE ROUTE 31
Mailing Address - Street 2:
Mailing Address - City:CICERO
Mailing Address - State:NY
Mailing Address - Zip Code:13039-9740
Mailing Address - Country:US
Mailing Address - Phone:315-706-7458
Mailing Address - Fax:
Practice Address - Street 1:2817 JAMES ST STE 211
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13206-2238
Practice Address - Country:US
Practice Address - Phone:315-706-7458
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-17
Last Update Date:2020-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory