Provider Demographics
NPI:1962479097
Name:GRAMIC RESEARCH LABORATORY, LLC
Entity Type:Organization
Organization Name:GRAMIC RESEARCH LABORATORY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPLE
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEYKIND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-669-8297
Mailing Address - Street 1:4330 SHERIDAN ST
Mailing Address - Street 2:#201B
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-1406
Mailing Address - Country:US
Mailing Address - Phone:954-962-1511
Mailing Address - Fax:954-962-9830
Practice Address - Street 1:4330 SHERIDAN ST
Practice Address - Street 2:#201B
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-1407
Practice Address - Country:US
Practice Address - Phone:954-962-1511
Practice Address - Fax:954-962-9830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-07
Last Update Date:2009-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL800020218291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL800020218OtherCLIA
FL800020218OtherCLIA