Provider Demographics
NPI:1982681953
Name:MANHATTAN PHYSICIANS LABORATORIES LLC
Entity Type:Organization
Organization Name:MANHATTAN PHYSICIANS LABORATORIES LLC
Other - Org Name:GENATOM LABORATORY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR VP
Authorized Official - Prefix:
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:PIRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-929-8890
Mailing Address - Street 1:25 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:PINE BROOK
Mailing Address - State:NJ
Mailing Address - Zip Code:07058-9391
Mailing Address - Country:US
Mailing Address - Phone:973-228-3099
Mailing Address - Fax:973-228-9123
Practice Address - Street 1:25 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:PINE BROOK
Practice Address - State:NJ
Practice Address - Zip Code:07058-9391
Practice Address - Country:US
Practice Address - Phone:973-228-3099
Practice Address - Fax:973-228-9123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-29
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ00003476291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2756200-01Medicaid
31D0106549OtherCLIA
301255Medicare ID - Type Unspecified