Provider Demographics
NPI:1134826324
Name:LIFEMAP DIAGNOSTIC LLC
Entity type:Organization
Organization Name:LIFEMAP DIAGNOSTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MOHAMED
Authorized Official - Middle Name:M
Authorized Official - Last Name:BAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-309-7098
Mailing Address - Street 1:375 N MAIN ST STE C4
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08094-1476
Mailing Address - Country:US
Mailing Address - Phone:732-309-7098
Mailing Address - Fax:
Practice Address - Street 1:375 N MAIN ST STE C4
Practice Address - Street 2:
Practice Address - City:WILLIAMSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08094-1476
Practice Address - Country:US
Practice Address - Phone:732-309-7098
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEALTH SERVE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-02-08
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory