MEDICARE: EZ LABS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory

General Provider Information

NPI Number	:	1114790094
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EZ LABS LLC

Provider Business Mailing Address
First Line	:	7503 WETHERINGTON DR
Second Line	:
City	:	WEST CHESTER
State	:	OH
Zip	:	45069-4612
Country	:	US
Telephone Number	:	937-222-3544
Fax Number	:	937-222-7122

Provider Business Practice Location Address
First Line	:	7503 WETHERINGTON DR
Second Line	:
City	:	WEST CHESTER
State	:	OH
Zip	:	45069-4612
Country	:	US
Telephone Number	:	937-222-3544
Fax Number	:	937-222-7122

Authorized Official
Title or Position	:	OWNER OF ENTITY
Name	:	SYED ASHFAQ HUSSAIN NAJEED
Credential	:	MD
Telephone Number	:	513-702-5799

Provider Enumeration Date	:	11/02/2023
Last Update Date	:	11/02/2023

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