Provider Demographics
NPI:1952621310
Name:PHYSICIANS MEDICAL LABORATORIES INC
Entity Type:Organization
Organization Name:PHYSICIANS MEDICAL LABORATORIES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GLADYS
Authorized Official - Middle Name:NGOZI
Authorized Official - Last Name:IBEZIM
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:973-619-2622
Mailing Address - Street 1:159 FRANKLIN ST
Mailing Address - Street 2:UNIT 3
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-4978
Mailing Address - Country:US
Mailing Address - Phone:973-619-2622
Mailing Address - Fax:973-677-1181
Practice Address - Street 1:159 FRANKLIN ST
Practice Address - Street 2:UNIT 3
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003-4978
Practice Address - Country:US
Practice Address - Phone:973-619-2622
Practice Address - Fax:973-677-1181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-09
Last Update Date:2010-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ31D1106597291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory