Provider Demographics
NPI:1831855576
Name:MEDARBOR LLC
Entity type:Organization
Organization Name:MEDARBOR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:MATT
Authorized Official - Middle Name:
Authorized Official - Last Name:LEGOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-590-0808
Mailing Address - Street 1:PO BOX 301
Mailing Address - Street 2:
Mailing Address - City:LINWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08221-0301
Mailing Address - Country:US
Mailing Address - Phone:888-590-0808
Mailing Address - Fax:267-573-3646
Practice Address - Street 1:5600 NW 102ND AVE STE GH
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33351-8709
Practice Address - Country:US
Practice Address - Phone:888-590-0808
Practice Address - Fax:267-573-3646
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEDARBOR LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-11-16
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory