Provider Demographics
NPI:1801324611
Name:PRIMBIO RESEARCH INSTITUTE LLC
Entity type:Organization
Organization Name:PRIMBIO RESEARCH INSTITUTE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:ZI
Authorized Official - Last Name:YE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-458-1112
Mailing Address - Street 1:4 DUDIE DR
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19073-4004
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3070 MCCANN FARM DR STE 112
Practice Address - Street 2:
Practice Address - City:GARNET VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19060-2131
Practice Address - Country:US
Practice Address - Phone:610-458-1112
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-24
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1033488300001Medicaid