Provider Demographics
NPI:1831222074
Name:PRINCETON BIOMEDICAL LABORATORIES
Entity type:Organization
Organization Name:PRINCETON BIOMEDICAL LABORATORIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:SYED
Authorized Official - Middle Name:IQBAL
Authorized Official - Last Name:HAIDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-785-5200
Mailing Address - Street 1:2921 VETERANS HWY
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:PA
Mailing Address - Zip Code:19007-1605
Mailing Address - Country:US
Mailing Address - Phone:215-785-5200
Mailing Address - Fax:215-785-6400
Practice Address - Street 1:2921 VETERANS HWY
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:PA
Practice Address - Zip Code:19007-1605
Practice Address - Country:US
Practice Address - Phone:215-785-5200
Practice Address - Fax:215-785-6400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA000156291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011208540004Medicaid
PA0011208540004Medicaid