MEDICARE: BRIGHTPOINT LABORATORIES 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	:	1467011700
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIGHTPOINT LABORATORIES LLC

Provider Business Mailing Address
First Line	:	71 W 23RD ST FL 8
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10010-3509
Country	:	US
Telephone Number	:	718-207-2505
Fax Number	:	646-380-1322

Provider Business Practice Location Address
First Line	:	12008 131ST ST
Second Line	:
City	:	SOUTH OZONE PARK
State	:	NY
Zip	:	11420-2922
Country	:	US
Telephone Number	:	718-207-2505
Fax Number	:	646-380-1322

Authorized Official
Title or Position	:	PRESIDENT
Name	:	HAL ROSE
Credential	:
Telephone Number	:	718-207-2505

Provider Enumeration Date	:	06/11/2019
Last Update Date	:	06/11/2019

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Directions to “BRIGHTPOINT LABORATORIES LLC ” Practice Location

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