Provider Demographics
NPI:1205093564
Name:CLINICAL LABORATORY COORDINATION SERVICE,INC.
Entity type:Organization
Organization Name:CLINICAL LABORATORY COORDINATION SERVICE,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:M
Authorized Official - Last Name:RYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-921-8833
Mailing Address - Street 1:2 ROOSEVELT AVE
Mailing Address - Street 2:LOWER LEVEL
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-3064
Mailing Address - Country:US
Mailing Address - Phone:516-921-8833
Mailing Address - Fax:516-921-9174
Practice Address - Street 1:2 ROOSEVELT AVE
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:SYOSSET
Practice Address - State:NY
Practice Address - Zip Code:11791-3064
Practice Address - Country:US
Practice Address - Phone:516-921-8833
Practice Address - Fax:516-921-9174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-22
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYAHP 1620347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle