MEDICARE: CAL - LAB PA

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	25MA02673100	NJ

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326030941
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAL - LAB PA

Provider Business Mailing Address
First Line	:	4567 CROSSROADS PARK DR
Second Line	:	2ND FLOOR
City	:	LIVERPOOL
State	:	NY
Zip	:	13088-3589
Country	:	US
Telephone Number	:	315-295-2100
Fax Number	:	315-295-2125

Provider Business Practice Location Address
First Line	:	550 NEWARK AVE
Second Line	:	SUITE 309
City	:	JERSEY CITY
State	:	NJ
Zip	:	07306-1326
Country	:	US
Telephone Number	:	201-792-6662
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF OPERATIONS
Name	:	DR. CALVIN L STRAND
Credential	:	M.D.
Telephone Number	:	201-792-6662

Provider Enumeration Date	:	08/19/2005
Last Update Date	:	03/18/2008

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Directions to “CAL - LAB PA ” Practice Location

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