Provider Demographics
NPI:1831698851
Name:ECONOMY LABORATORY LLC
Entity type:Organization
Organization Name:ECONOMY LABORATORY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:AUDREY
Authorized Official - Middle Name:MAE
Authorized Official - Last Name:HOLLANDER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:321-349-0456
Mailing Address - Street 1:1954 DAIRY RD
Mailing Address - Street 2:
Mailing Address - City:W MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32904-4045
Mailing Address - Country:US
Mailing Address - Phone:321-349-0456
Mailing Address - Fax:321-837-3954
Practice Address - Street 1:466 N HARBOR CITY BLVD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935
Practice Address - Country:US
Practice Address - Phone:321-349-0456
Practice Address - Fax:321-425-2382
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ECONOMY LABORATORY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-02-05
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10D1102378291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory