Provider Demographics
NPI:1396746673
Name:LABORATORY ALLIANCE OF CENTRAL NEW YORK, LLC
Entity type:Organization
Organization Name:LABORATORY ALLIANCE OF CENTRAL NEW YORK, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RITA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROMANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-461-3036
Mailing Address - Street 1:115 CONTINUUM DR STE 2A
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13088-4387
Mailing Address - Country:US
Mailing Address - Phone:315-461-3006
Mailing Address - Fax:315-461-3090
Practice Address - Street 1:113 INNOVATION LN
Practice Address - Street 2:
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13088-6061
Practice Address - Country:US
Practice Address - Phone:315-453-7200
Practice Address - Fax:315-461-3030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-09
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY33D0954150291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1978849Medicaid
NY1978849Medicaid