Provider Demographics
NPI:1811325442
Name:EXPERTUS LABORATORIES, INC
Entity type:Organization
Organization Name:EXPERTUS LABORATORIES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:WEIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-375-8599
Mailing Address - Street 1:195 WEKIVA SPRINGS RD STE 200
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32779-3696
Mailing Address - Country:US
Mailing Address - Phone:407-375-8599
Mailing Address - Fax:407-459-8845
Practice Address - Street 1:1701 GREEN RD
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33064-1074
Practice Address - Country:US
Practice Address - Phone:407-459-8845
Practice Address - Fax:407-459-8845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-16
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
291U00000X
FL291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1811325442OtherNPI