Provider Demographics
NPI:1770374241
Name:SYNERGY LAB SPOT
Entity type:Organization
Organization Name:SYNERGY LAB SPOT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:445-206-2025
Mailing Address - Street 1:917 ARCH ST APT 408
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-2446
Mailing Address - Country:US
Mailing Address - Phone:445-206-2025
Mailing Address - Fax:833-463-2146
Practice Address - Street 1:917 ARCH ST 107 PHILADELPHIA PA 19107
Practice Address - Street 2:107
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107
Practice Address - Country:US
Practice Address - Phone:445-206-2025
Practice Address - Fax:833-463-2146
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-14
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty