Provider Demographics
NPI:1770717365
Name:PENNJE LABORATORY SERVICES, LLC
Entity type:Organization
Organization Name:PENNJE LABORATORY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MOHAMED
Authorized Official - Middle Name:A
Authorized Official - Last Name:ABDULLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD, FCAP
Authorized Official - Phone:484-821-0520
Mailing Address - Street 1:2591 BAGLYOS CIRCLE
Mailing Address - Street 2:SUITE C-48
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18020
Mailing Address - Country:US
Mailing Address - Phone:484-821-0520
Mailing Address - Fax:484-821-0530
Practice Address - Street 1:2591 BAGLYOS CIRCLE
Practice Address - Street 2:SUITE C-48
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18020
Practice Address - Country:US
Practice Address - Phone:484-821-0520
Practice Address - Fax:484-821-0530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-11
Last Update Date:2009-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNJ-25MA07827100207ZC0500X, 207ZD0900X, 207ZP0101X
NYMYC-232717207ZC0500X
PAPA-MD047282L207ZC0500X, 207ZD0900X, 207ZP0101X
NYNY-232717207ZD0900X
NYNYC-232717207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic PathologyGroup - Multi-Specialty
No207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathologyGroup - Multi-Specialty
No207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0060275Medicaid