Provider Demographics
NPI:1932378569
Name:LIBERTY TESTING LABORATORIES, INC
Entity Type:Organization
Organization Name:LIBERTY TESTING LABORATORIES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JERROLD
Authorized Official - Middle Name:E
Authorized Official - Last Name:LUSTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-546-0200
Mailing Address - Street 1:27 WATER ST
Mailing Address - Street 2:SUITE 213
Mailing Address - City:WAKEFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01880-3032
Mailing Address - Country:US
Mailing Address - Phone:706-546-0200
Mailing Address - Fax:706-546-6522
Practice Address - Street 1:27 WATER ST
Practice Address - Street 2:SUITE 213
Practice Address - City:WAKEFIELD
Practice Address - State:MA
Practice Address - Zip Code:01880-3032
Practice Address - Country:US
Practice Address - Phone:706-546-0200
Practice Address - Fax:706-546-6522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-28
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory