Provider Demographics
NPI:1972648228
Name:MARINA DIAGNOSTIC LAB LLP
Entity Type:Organization
Organization Name:MARINA DIAGNOSTIC LAB LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LAB DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:IRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:GUTNIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-332-5678
Mailing Address - Street 1:1711 SHEEPSHEAD BAY ROAD
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235
Mailing Address - Country:US
Mailing Address - Phone:718-332-5678
Mailing Address - Fax:718-934-1780
Practice Address - Street 1:1711 SHEEPSHEAD BAY ROAD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235
Practice Address - Country:US
Practice Address - Phone:718-332-5678
Practice Address - Fax:718-934-1780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory