MEDICARE: LENCO DIAGNOSTIC LABORATORIES,INC.

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	8094	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255468328
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LENCO DIAGNOSTIC LABORATORIES,INC.

Provider Business Mailing Address
First Line	:	1857 86TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11214-3108
Country	:	US
Telephone Number	:	718-232-1515
Fax Number	:

Provider Business Practice Location Address
First Line	:	1857 86TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11214-3108
Country	:	US
Telephone Number	:	718-232-1515
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	IRINA TYLMAN
Credential	:
Telephone Number	:	718-232-1515

Provider Enumeration Date	:	02/27/2007
Last Update Date	:	04/22/2020

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