Provider Demographics
NPI:1770616534
Name:LABORATORY FOR STONE RESEARCH
Entity type:Organization
Organization Name:LABORATORY FOR STONE RESEARCH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:L
Authorized Official - Last Name:PRIEN
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:617-244-2516
Mailing Address - Street 1:PO BOX 129
Mailing Address - Street 2:81 WYMAN STREET
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02468
Mailing Address - Country:US
Mailing Address - Phone:617-244-2516
Mailing Address - Fax:617-244-2515
Practice Address - Street 1:81 WYMAN STREET
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02468
Practice Address - Country:US
Practice Address - Phone:617-244-2516
Practice Address - Fax:617-244-2515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5278291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
228084Medicare ID - Type Unspecified