Provider Demographics
NPI:1134439573
Name:STAR LABORATORY
Entity type:Organization
Organization Name:STAR LABORATORY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SAM
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAWAJA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-529-5100
Mailing Address - Street 1:125 FLEMING ST
Mailing Address - Street 2:
Mailing Address - City:PISCATAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08854-3350
Mailing Address - Country:US
Mailing Address - Phone:732-529-5100
Mailing Address - Fax:732-474-0923
Practice Address - Street 1:125 FLEMING ST
Practice Address - Street 2:
Practice Address - City:PISCATAWAY
Practice Address - State:NJ
Practice Address - Zip Code:08854-3350
Practice Address - Country:US
Practice Address - Phone:732-529-5100
Practice Address - Fax:732-474-0923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-19
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ0004918291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0004918OtherLABORATORY