Provider Demographics
NPI:1992838502
Name:UNITED MEDICAL LABORATORY INC
Entity Type:Organization
Organization Name:UNITED MEDICAL LABORATORY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:FARID
Authorized Official - Middle Name:
Authorized Official - Last Name:HASSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-843-7750
Mailing Address - Street 1:12 OVERLOOK AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHELLE PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07662-3226
Mailing Address - Country:US
Mailing Address - Phone:201-843-7750
Mailing Address - Fax:
Practice Address - Street 1:12 OVERLOOK AVE
Practice Address - Street 2:
Practice Address - City:ROCHELLE PARK
Practice Address - State:NJ
Practice Address - Zip Code:07662-3226
Practice Address - Country:US
Practice Address - Phone:201-843-7750
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2011-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ31D0933244291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0183865Medicaid
NJ0183865Medicaid
NJ341044Medicare ID - Type Unspecified