Provider Demographics
NPI:1780691089
Name:NOVA LAB EQUIPMENT, CORP
Entity type:Organization
Organization Name:NOVA LAB EQUIPMENT, CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:A
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-512-1385
Mailing Address - Street 1:9807 NW 80 AVE BAY 11 J
Mailing Address - Street 2:
Mailing Address - City:HIALEAH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33016
Mailing Address - Country:US
Mailing Address - Phone:305-512-1385
Mailing Address - Fax:305-512-1396
Practice Address - Street 1:9807 NW 80TH AVE UNIT 11J
Practice Address - Street 2:
Practice Address - City:HIALEAH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33016-2325
Practice Address - Country:US
Practice Address - Phone:305-512-1385
Practice Address - Fax:305-512-1396
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5780410001Medicare NSC