Provider Demographics
NPI:1013099605
Name:BOSTWICK LABORATORIES, INC,
Entity Type:Organization
Organization Name:BOSTWICK LABORATORIES, INC,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:STEFANELLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-512-5200
Mailing Address - Street 1:PO BOX 403751
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-3751
Mailing Address - Country:US
Mailing Address - Phone:804-967-9225
Mailing Address - Fax:804-239-1954
Practice Address - Street 1:100 CHARLES LINDBERGH BLVD
Practice Address - Street 2:BOSTWICK LABORATORIES, INC.
Practice Address - City:UNIONDALE
Practice Address - State:NY
Practice Address - Zip Code:11553-3631
Practice Address - Country:US
Practice Address - Phone:804-967-9225
Practice Address - Fax:804-239-1954
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1009021320003Medicaid
CO79430881Medicaid
UT1013099605Medicaid
WV3810015664Medicaid
AZ443513Medicaid
WY127456200Medicaid
IA1013099605Medicaid
VA138056OtherANTHEM BCBS OF VIRGINIA
LA1372021Medicaid
IN200931890AMedicaid
OH000000265165Medicaid
OK200024720DMedicaid
WA7147846Medicaid
WI100003869Medicaid
VA1013099605Medicaid
AL10111299Medicaid
NC7001365Medicaid
AZ443513Medicaid
WV3810015664Medicaid
CO79430881Medicaid
WY127456200Medicaid