Provider Demographics
NPI:1932723699
Name:CITYWIDE MEDICAL LAB LLC
Entity Type:Organization
Organization Name:CITYWIDE MEDICAL LAB LLC
Other - Org Name:CITYWIDE MEDICAL LAB LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NATALYA
Authorized Official - Middle Name:
Authorized Official - Last Name:BILIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-768-9695
Mailing Address - Street 1:1000 PARK CENTRE BLVD STE 150
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33169-5352
Mailing Address - Country:US
Mailing Address - Phone:305-768-9695
Mailing Address - Fax:305-768-9698
Practice Address - Street 1:1000 PARK CENTRE BLVD STE 150
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33169-5352
Practice Address - Country:US
Practice Address - Phone:305-768-9695
Practice Address - Fax:305-768-9698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-28
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory