Provider Demographics
NPI:1629872478
Name:AMTAJ ENTERPRISE LLC
Entity type:Organization
Organization Name:AMTAJ ENTERPRISE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPECIMEN COLLECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SASHAI
Authorized Official - Middle Name:
Authorized Official - Last Name:LAING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-741-3161
Mailing Address - Street 1:15 MIRIN AVE
Mailing Address - Street 2:
Mailing Address - City:ROOSEVELT
Mailing Address - State:NY
Mailing Address - Zip Code:11575-1603
Mailing Address - Country:US
Mailing Address - Phone:347-741-3161
Mailing Address - Fax:347-741-3161
Practice Address - Street 1:15 MIRIN AVE
Practice Address - Street 2:
Practice Address - City:ROOSEVELT
Practice Address - State:NY
Practice Address - Zip Code:11575-1603
Practice Address - Country:US
Practice Address - Phone:347-741-3161
Practice Address - Fax:347-741-3161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-02
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory